PRE-CONFERENCE WORKSHOPS

Tuesday 22nd July 2014.
9.30 am - 5.00pm

A programme of one-day workshops will be held on Tuesday 22nd July. These workshops offer participants an opportunity to develop practical skills in the assessment and treatment of a range of problems.

Click here to download the workshop handout.


  Tuesday 22nd July
 

Using Behavioural Experiments and Imagery to Create New Ways of Being

James Bennett-Levy, University of Sydney, Australia

Workshop 1 - Full details

Behavioural experiments and imagery interventions are regarded as two of the most powerful techniques in CBT. They tend to arouse strong emotion and “hot cognitions.” Theories from clinical science suggest that the reason for their effectiveness is that they impact at a different level of processing from more rationalistic cognitive techniques.

Following presentation of a conceptual framework and tips for using imagery and behavioural experiments, this workshop will be mainly self-experiential. Participants will select a professional or personal issue of mild to moderate emotional intensity to work on: something they regard as an unhelpful way of being. Imagery and behavioural experiments will then be used as two of the key strategies to create and strengthen new ways of being.
The workshop is derived from the presenter’s forthcoming book CBT from the Inside Out: A Self-practice/Self-reflection Workbook for Therapists, and from previous books, the Oxford Guide to Behavioural Experiments in Cognitive Therapy and the Oxford Guide to Imagery in Cognitive Therapy.
Just as experiential CBT techniques can make a significant difference for clients, so our experience suggests that participants tend to learn more about behavioural experiments and imagery by engaging self-experientially rather than by just ‘being told’ or observing.  This workshop provides an opportunity not just to learn about CBT, but to cultivate a different way of being personally or professionally.

Learning Objectives

  • To enhance understanding of behavioural experiments and imagery, and skills, through provision of conceptual frameworks to guide implementation
  • To enhance therapeutic skills by experiencing behavioural experiments and imagery from the Inside Out.
  • To enhance therapist confidence in using behavioural experiments and imagery
  • To give participants an experience of the value of self-practice of CBT techniques and self-reflection as a way to broaden their understanding of CBT and deepen their skills

Initial presentation of theory and techniques will be didactic, and through modeling and socratic questioning. For the remainder of the workshop, the predominant mode of learning will be through role-play, self-experiential practice and self-reflection.

References/further reading

  • Bennett-Levy, J., Thwaites, R., Haarhoff, B. & Perry, H. (2014, in press): CBT from the inside out: A self-practice/self-reflection workbook for therapists. Guilford, New York.
  • Hackmann, A., Bennett-Levy, J. & Holmes, E.A. (2011).  The Oxford guide to imagery in cognitive therapy.  Oxford University Press, Oxford.

 

  • Bennett-Levy, J., Butler, G., Fennell, M.J.V., Hackmann, A., Mueller, M. & Westbrook, D. (Eds.) (2004):  The Oxford guide to behavioural experiments in cognitive therapy.  Oxford University Press, Oxford.
 

MBCT In Clinical Practice, including Anxious Clients

Sandra Coffman, University of Washington, USA

Workshop 2 - Full details

MBCT has repeatedly been proven to reduce relapse of depression in certain populations.  Additional research now highlights the effectiveness for MBCT in reducing anxiety.   In clinical practice, many depressed participants often have co-occurring anxiety disorders.  Preparing to address the needs of these participants and issues can expand the availability of MBCT to more populations and improve leader effectiveness.

Learning Objectives
By the end of the class the participants will be able to:

  • Modify MBCT information to include examples of anxiety-based thoughts and feelings;
  • Include the CBT & MBCT view of anxiety in examples and exercises;
  • Modify class discussions to include likely relapse –inducing situations, thoughts and feelings caused by anxiety as well as by depression.

The training modalities will include didactic instruction, modeling and skills practice, including role-plays. Meditation sessions will be followed by inquiry concerning participants own experiences, as well as those of clients they are role playing.

Implications in everyday clinical practice of CBT
Given the frequent co-morbidity of depression and anxiety, practicing these strategies will more effectively prepare leaders for leading MBCT and reducing suffering for participants who suffer from anxiety as well as, or in addition to, depression.

Sandra J. Coffman, Ph.D.  has provided CBT for depression and anxiety in her clinical practice for over 30 years in Seattle Washington.  An Associate Clinical Professor at the University of Washington and a founding member of the Academy of Cognitive Therapy, she supervises students and professionals.  She has offered MBCT groups to the community for over 10 years, written about and  taught these skills to other professionals.

References/further reading

  • Mark A. Craigie, Clare S. Rees, Ali Marsh, and Paula Nathan.  Mindfulness-based Cognitive Therapy for Generalized Anxiety Disorder: A Preliminary Evaluation.  Behavioural and Cognitive Psychotherapy. 2009 October; 36, 05:  553-568.
  • J.M.G. Williams, Y. Alatiq, C. Crane, T. Barnhofer, M.J.V. Fennell, D.S. Duggan, S. Hepburn, and G.M. Goodwin.  Mindfulness-based Cognitive Therapy (MBCT) in bipolar disorder:  Preliminary evaluation of immediate effects on between-episode functioning. J Affect Disord. 2008 April; 107(1-3): 275–279.
  • Stefan G. Hofmann, Alice T. Sawyer, Ashley A. Witt, and Diana Oh.  The effect of mindfulness-based therapy on anxiety and depression:  a met-analytic review. J Consult Clin Psychol. 2010 April; 78(2): 169–183.
 

Assessing and treating insomnia in everyday clinical practice

Colin Espie, University of Oxford, UK

Workshop 3 - Full details

Insomnia Disorder is the most common mental health problem in the UK yet most clinicians feel poorly equipped to diagnose, assess and manage it. Moreover, sleep  is commonly mistaken as merely a passive state, rather than a primary driver of emotional regulation. This workshop addresses the fundamental importance of sleep. It will offer new insights, and provide practical cognitive behavioural skills to work with people who have sleep problems comorbid with other mental health problems.  

Learning Objectives

  • Understand the relationship between sleep, circadian function and emotion
  • Acquire diagnostic and practical appraisal skills regarding insomnia
  • Acquire cognitive and behavioural skills that can be used with most patients

There will be case discussion, illustration, web and mobile therapy presentations, illustrated assessment and therapy materials.

Colin Espie is a Professor in the Nuffield Department of Clinical Neuroscience at the University of Oxford and closely involved with the development of the Sleep & Circadian Neuroscience Institute (SCNi). Previously, he was founding Director of the University of Glasgow Sleep Centre, and is an Emeritus Professor in the College of Medical, Veterinary and Life Sciences at the University of Glasgow. Colin also holds or have held adjunct or visiting professorial appointments at the Universities of Sydney, Rome (la Sapienza), Laval (Quebec City) and Rochester (NY).
Professor Espie’s particular areas of research expertise are in the assessment and treatment of sleep disorders, most particularly the management of insomnia using Cognitive Behavioural Therapy (CBT), and in studies on the aetiology and pathophysiology of insomnia.

 

DBT for Personality disorders and beyond

Janet Feigenbaum, University College, London, UK

Workshop 4 - Full details

Dialectical Behavioural Therapy (DBT) was originally developed for the treatment of women with Borderline Personality Disorder (BPD) with high risk behaviours (Linehan, et al., 1991). Since the first trial, a number of replication studies have been conducted to confirm the efficacy of DBT which has led to the recommendation by NICE of DBT for BPD in women. The effectiveness trials are now emerging suggesting that implementation of DBT may be somewhat more challenging than indicated by efficacy trials. In parallel with the development of the evidence base for DBT for BPD a number of adaptations of DBT for a range on clinical presentations and clinical sites have been developed and are being evaluated including for: binge eating disorder, bulimia, older adults with chronic resistant depression, suicidal adolescents, adult ADHS, in-patient services, cluster C personality disorders, PTSD, and forensic populations. In addition dismantling studies have begun to address the question of for whom fully programmatic DBT is necessary or can some modalities of the treatment programme be sufficient.

The workshop will review and demonstrate the principles and practice of standard DBT and adaptations of DBT across a range of settings and populations. The workshop will highlight the issues involved in adoption versus adaptation of DBT for the clinician’s local needs and provide guidance on the steps to implementation of a DBT programme.

Learning Objectives
•          To describe the theoretical principles of the DBT model
•          To describe and demonstrate the key DBT strategies (Including demonstration and tips on teaching DBT skills to clients)
•          To highlight the issues of adoption and adaptation of DBT
•          To provide advice on developing a DBT programme or adaptation of DBT

Training modalities will include didactic, Role play, Demonstration (modelling), discussion and consultation

Implications for everyday clinical practice of CBT
DBT is recommended by NICE guidelines for women with BPD. The evidence base for DBT has been increasing, with a range of adaptations for other populations and clinical settings. An understanding of the principles and practice of DBT will provide clinicians with the fundamentals needed to consider how to develop DBT within their local setting.

Dr. Feigenbaum is a senior lecturer at University College London in clinical psychology and Strategic and Clinical Lead for Personality Disorder Services in North East London NHS Foundation Trust. She was research director of the first effectiveness trial of DBT in the UK (Feigenbaum et al., 2011).  Her clinical service, IMPART, was originally developed as one of the 11 National Pilot sites for Personality Disorder in the UK in 2003, and in 2011 was selected as one of the three IAPT SMI demonstration sites for personality disorder. She has been a member of the British Isles DBT training team since 2006. She is chairman of the board of Accreditation in DBT for the Society for DBT.  Her current research interests are in DBT for employment and DBT for self harm in A&E.

References/further reading

  1. Feigenbaum, Janet. "Dialectical behaviour therapy: An increasing evidence base." Journal of Mental Health 16.1 (2007): 51-68.
  1. Feigenbaum, Janet D., et al. "A real‐world study of the effectiveness of DBT in the UK National Health Service." British Journal of Clinical Psychology 51.2 (2012): 121-141.
  1. Rizvi, Shireen L., Lauren M. Steffel, and Amanda Carson-Wong. "An overview of dialectical behavior therapy for professional psychologists." Professional Psychology: Research and Practice 44.2 (2013): 73.
  1. Carmel, Adam, Monica Leila Rose, and Alan E. Fruzzetti. "Barriers and Solutions to Implementing Dialectical Behavior Therapy in a Public Behavioral Health System." Administration and Policy in Mental Health and Mental Health Services Research (2013): 1-7.
 

Thinking the way out of addiction

Matt Field, University of Liverpool and
Frank Ryan, Imperial College, London, UK

Workshop 5 - Full details

CBT for addiction rests on the assumption that clients are able to identify ways of thinking that lead them to consume alcohol and other drugs. However, research into implicit cognitive processes and self-control suggests that some important determinants of addictive behaviour may not be consciously accessible. In this workshop we will review the evidence regarding distorted implicit cognitive processes and poor self-control, and consider their role in recovery and relapse in addiction. We will discuss how these cognitive processes can be successfully modified, either by direct ‘cognitive training’ approaches or by adapting existing techniques.

Learning objectives

  • You will understand the limitations of self-report measures of ‘controlled’ processes in addiction
  • You will be able to critically evaluate the evidence base for biases in implicit cognitive processes and deficits in cognitive control in addiction, and consider their clinical relevance.
  • You will understand the evidence base for the effectiveness of diverse ‘cognitive training’ interventions for addiction, and be able to identify the problems and pitfalls that affect this growing research topic.
  • You will be able to develop new therapy techniques and adapt existing techniques so that you are better able to target the distorted cognitive processes that maintain addiction.

Implications for everyday clinical practice of CBT
Some of the automatic cognitive processes implicated in addictive behaviour may not be amenable to conventional CBT techniques. Alternative therapeutic techniques such as ‘cognitive training’ or variations on more established therapies might be of some benefit.

Matt Field is an experimental psychologist who conducts research into cognitive processes in alcohol problems and other addictions, with a focus on implicit cognition and cognitive control. Frank Ryan is a practising clinical psychologist with similar interests who has developed practical applications of this research.

References/further reading

  • Field, M., Marhe, R., & Franken, I. H. A. (2014). The clinical relevance of attentional bias in substance use disorders. CNS Spectrums, in press, DOI: 10.1017/S1092852913000321.
  • Ryan, F. (2013). Cognitive Therapy for Addiction: Motivation and Change. John Wiley & Sons.

 

  • Stacy, A. W. & Wiers, R. W. (2010). Implicit cognition in addiction: a tool for explaining paradoxical behaviour. Annual Review of Clinical Psychology, 6, 551-575.
 

Developments in CBT for persecutory delusions

Daniel Freeman, Katherine Pugh and Felicity Waite, University of Oxford, UK

Workshop 6 - Full details

Persecutory delusions are one of the most frequent and distressing symptoms of psychosis. In the last ten years they have become the focus of considerable psychological research. This research is being used by Prof Daniel Freeman and colleagues to develop a targeted cognitive therapy for individuals with paranoia. The workshop will present the latest developments in the psychological treatment of paranoia being evaluated by Prof Freeman’s team, including reducing preoccupation with delusions, improving sleep, and increasing self confidence.

Key learning objectives
After attending this course delegates will be able to:

  • Be aware of state of the art approaches for reducing persecutory delusions
  • Identify key targets in therapy for persecutory delusions
  • Know a range of techniques for reducing worry, improving sleep, and enhancing self-confidence in patients with persecutory delusions.

The workshop will consist of didactic teaching, discussion, role-play, and video extract.

Implications for everyday clinical practice of CBT
The targets of therapy described in this workshop – such as reducing worry, improving sleep, and enhancing self-confidence – are popular with patients and hence improve engagement. Moreover, the evidence indicates that working on these targets also reduces the paranoia. The workshop will describe the key techniques used by our team with patients with persecutory delusions.

Daniel Freeman is a Professor of Clinical Psychology and MRC Senior Clinical Fellow in the Department of Psychiatry at the University of Oxford. He is also an honorary consultant clinical psychologist in Oxford Health NHS Foundation Trust and a Fellow of University College, Oxford. He has published extensively on the psychological understanding and treatment of persecutory delusions, and is the lead author of several books including Overcoming Paranoid and Suspicious Thoughts (2006), Paranoia: the 21st Century Fear (2008), Know Your Mind (2009), You Can Be Happy (2012), and The Stressed Sex (2013).  Drs Katherine Pugh and Felicity Waite are clinical psychologists working within Prof Freeman’s group on clinical trials evaluating treatment innovations for patients with persecutory delusions.

References/further reading

  • Freeman, D. (2011). Improving cognitive treatments for delusions. Schizophrenia Research, 132, 135-139.
  • Freeman, D. & Freeman, J. (2013). How to Keep Calm and Carry On: Inspiring Ways to Worry Less and Live a Happier Life. Pearson Business.
 

An introduction to compassion focused therapy

Paul Gilbert, University of Derby

Workshop 7 - Full details

Part 1 of this workshop will introduce the CFT model of compassion and focus on the nature of the evolved mind and the three system of affect regulation. We will explore the origins of CFT arising from problems associated with helping people with high shame and self-criticism who find relating to themselves affiliatively very difficult.

Part 2 will introduce some of the practices that are used to cultivate compassion. These will include attention training, soothing rhythm breathing, safe placed imagery, compassionate self-cultivation, compassionate-self focusing and compassion image focusing. Participants will be engaged in personal practice and trying out these practices.

Learning Objectives

  • Participants will learn about the origins of CFT and how it has developed for people with high shame self-criticism –and the different types of shame and self-criticism
  • participants will understand the process of compassion as flow: the compassion we feel for others; the compassion we are open to from others; and self-compassion
  • participants will recognise how different practices focus on different elements of this “flow” and be able to recognise which practices go with which focus for compassion.
  • Participants will learn how to use imagery for compassion practice

Paul Gilbert OBE is Professor of Clinical Psychology at the University of Derby and Consultant Clinical Psychologist at the Derbyshire Health Care Foundation Trust. He has researched evolutionary approaches to psychopathology for over 35 years with a special focus on shame and the treatment of shame based difficulties - for which compassion focused therapy was developed. In 2003 he was president of the BABCP and an member of the first NICE depression guidelines for depression. He has written/edited 20 books and over 150 papers. In 2006 he established the Compassionate Mind Foundation charity with the mission statement To promote wellbeing through the scientific understanding and application of compassion (www.compassionatemind.co.uk). He was awarded an OBE in March 2011.

References/further reading

  • Gilbert, P. (2010). The Compassionate Mind. A New Approach to the Challenges of Life:. New York: New Harbinger.
  • Gilbert, P. (2010). Compassion Focused Therapy. Distinctive Features. London: Routledge.
  • Gilbert, P. (ed.). (2010). Compassion Focused Therapy: Special Issue. International Journal of Cognitive Therapy. 3, 97-201.
  • Gilbert P & Choden  (2013) Mindful Compassion. London Constable Robinson
 

CBT for emotional problems after stroke

Ian Kneebone, University of Western Sydney, Australia

Workshop 8 - Full details

Over 100,000 people in the UK experience a stroke each year. Problems after stroke can include inability to walk, to wash and dress independently and communication difficulties. In addition at least 35 per cent of those with stroke will have cognitive (e.g., memory/ concentration) impairment, and many will suffer emotional difficulties (e.g., 20-30% will suffer from depression and /or anxiety at a given time point). This workshop will consider stroke and its emotional impact. The best means for identifying and monitoring change in emotional difficulties after stroke will be reviewed and a framework for modified CBT intervention will be considered. Particular attention will be given in the workshop to managing fear of falling, a common problem after stroke. The workshop will be informed by the current evidence base for CBT after stroke and include role play exercises and video of live casework.

Learning Objectives
Participants:
1.         Will be aware of the best instruments to use to screen for emotional problems after stroke.
2.         Will be able to inform their CBT practice with those who have had a stroke by use of an heuristic framework developed specific to practice with this population
3.         Will be able to assess and treat people encountering fear of falling post stroke
The Workshop will include presentations, role plays, video of live casework.

Implications for everyday clinical practice of CBT
Participation in this workshop will allow therapists to tailor their interventions to meet the particular challenges posed by practice in those affected emotionally after surviving stroke.

Ian has specialised in rehabilitation and worked with older and younger people who have encountered stroke for over twenty years. He is an internationally acknowledged expert on the psychological treatment of emotional disorders after stroke and a co-author of “Psychological Management of Stroke” (Wiley, 2012).

References/further reading

  1. Lincoln, N., Kneebone, I. I., Macniven, J., & Morris, R. (2012). Psychological management of stroke. Wiley: Chichester, UK.
  1. Kneebone, I. I., & Jeffries, F. W. (2013). Treating anxiety after stroke using cognitive behaviour therapy: Two cases. Neuropsychological Rehabilitation, 23, 798 – 810.
 

 

 

Workshop 9 has been cancelled.

 

 

Brief Behavioral Activation for Depression: Principles, Procedures, and Applications

Carl Lejuez, University of Maryland, USA

Workshop 10 - Full details

Behavioral Activation (BA) is a treatment approach aimed and building resiliency across domains with structure and accountability. This workshop presents the Brief Behavioral Activation Treatment for Depression (BATD). There is a wealth of supportive data for BA approaches more generally and BATD specifically, for treating depression and associated comorbidities. This workshop will begin with an overview of the history and basic underlying principles of BATD as well as the existing empirical support, followed by a review of the key procedures presented in a practical and hands on manner, concluding with a discussion of how to extend the approach to a range of clinical conditions and how to address treatment barriers as they arise.

Learning Objectives

  • Learn the history of Behavioral Activation
  • Understand empirical support for Behavioral Activation
  • Become familiar with the basic principles underlying BATD.
  • Learn how to use BATD to treat depression
  • Learn to integrate BATD with other approaches in therapy and understand how it fits with the unique aspects of your clinical setting.
  • Learn how BATD can also be applied to co-existent conditions including anxiety, substance use, and chronic medical conditions
  • Be able to spot and address treatment barriers

Implications for everyday clinical practice of CBT
My recent interest is in leveraging the simplicity and generality of BATD, using it in settings where traditional psychological approaches may be less useful because they are too complicated or relevant only for a specific disorder, which often requires therapists to be highly trained in multiple approaches which rarely is feasible. So in a way BATD is a bit of a swiss army knife that allows a clinician to handle the complexities of real world clinical practice in a way that draws from the strengths of empirically supported manualized approaches, without the typical rigidity and narrowness. 

Dr. Lejuez received his graduate training at West Virginia University, earning his PhD in 2000 after completing a Clinical Internship at the Brown University Clinical Psychology Training Consortium. He completed a sabbatical in 2008 at the Yale Child Study Center. He is currently a Professor and the Director of Clinical Training in the Clinical Psychology Program at the University of Maryland, as well as the Founding Director of the Center for Addictions, Personality, and Emotion Research (CAPER). He is a developer of the Brief Behavioral Activation Treatment for Depression (with Derek Hopko) and his work is now exploring the use of this approach across a range of clinical condition including anxiety, trauma, and substance use. He has published over 200 peer-reviewed articles and book chapters, has been the recipient of several early career awards, and his research has been constantly funded by the National Institutes of Health since his arrival at Maryland in 2001.

References/further reading

  • Magidson, J. F., Roberts, B. W., Collado, A., & Lejuez, C. W. (in press). Theory-driven intervention for changing personality: Expectancy value theory, behavioral activation, and conscientiousness. Developmental Psychology. 
  • Magidson, J. F., Gorka, S. M., MacPherson, L. M., Hopko, D. R., Blanco, C., Lejuez, C. W., Daughters, S. B. (2011). Examining the effect of the life enhancement treatment for substance use (LETS ACT) on residential substance abuse treatment retention. Addictive Behaviors, 36, 615-623. PMCID: PMC3070865. doi:10.1016/j.addbeh.2011.01.016.
  • 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: Revised treatment manual. Behavior Modification, 35, 111-161. doi:10.1177/0145445510390929.
 

Integrative Behavioral Couple Therapy in Clinical Settings

Christopher Martell, University of Wisconsin, USA

Workshop 11 - Full details

Marriage is changing throughout the world.   Many countries allow same-sex couples to legally marry or form civil unions.  At the same time, divorce rates in “traditional” marriages continue to remain high.  Integrative Behavioral Couple Therapy (IBCT, Jacobson et al., 2000) is an empirically based treatment that includes behavioral exchange, communication and problem-solving techniques within a therapy that emphasizes attention to emotion, and broader thematic problem formulation.

Conducting IBCT in real world clinical settings as presented in this workshop consists of three components:
(i)         Conducting a good assessment of the couple as of each individual in the couple (typically 3 sessions)
(ii)        Presenting a formulation to the couple (1 session)
(iii)       Ongoing debriefing of problematic situations over the course of treatment.

Learning Objectives
Participants will acquire the following skills:

  • Conducting an evaluation and interview with couples that will allow development of a workable formulation.
  • Developing a formulation that will be used throughout treatment.
  • Strategies for engaging couples in treatment to shift problematic interaction patterns.
  • Ideas for balancing acceptance and change throughout treatment.
  • Strategies for modifying treatment according to demands of diverse clinical settings.

In this workshop didactics will be balanced with video demonstrations and practice (role-play) exercises.

Christopher Martell, Ph.D., ABPP is a Clinical Professor of Psychology at the University of Wisconsin – Milwaukee, where he is the Coordinator of the Psychology training clinic.   Professor Martell spent 23 years in independent practice in Seattle, Washington, USA, where he was also on clinical faculty in the psychology and psychiatry departments at the University of Washington.  He was a research therapist on three nationally funded Randomized Control Trials of psychotherapy, including a multi-site study of IBCT and traditional behavioral couple therapy. A co-author of seven books and numerous articles, he is an expert on behavioral activation in the treatment of depression, IBCT, and applications of CBT with sexual minority client.

References/further reading

  • Atkins, D. C., Berns, S. B., George, W. H., Doss, B.D., Gallis, K. & Christensen, A. (2005).   Prediction of response to treatment in a randomized control trial of marital therapy.  Journal of Consulting and Clinical Psychology, 73(5), 893-903
  • Christensen, A, Atkins, D. C., Baucom, B & Yi, J (2010). Marital status and satisfaction five years following a randomized clinical trial of traditional versus behavioral couple therapy. JCCP, 78, 225-235
  • Christensen, A., Atkins, D.C., Berns, S., Wheeler, J., Baucom, D. H. & Simpson, L. E. (2004).  Traditional versus Integrative Behavioral Couple Therapy for significantly and chronically distressed married couples.  Journal of Consulting and Clinical Psychology, 176 – 191
  • Christensen, A., Yi, J., Atkins, D. C. Baucom, D. H., & George, W. H. (2006).  Journal of Consulting and Clinical Psychology, 74(6), 1180 – 1191

  • Jacobson, N.S., Christensen, A., Prince, S. E., Cordova, J., & Eldrige, K. (2000).  Integrative behavioral couple therapy: An acceptance-based, promising new treatment for couple discord.  Journal of Consulting and Clinical Psychology, 68(2), 351-355
 

Complications in the Treatment of Anxiety Disorders: Addressing Co-Occurring Substance Use Disorder

Katherine McHugh, Harvard Medical School, USA

Workshop 12 - Full details

Substance use and substance use disorders are highly prevalent among individuals with anxiety disorders, and can interfere with the implementation and effectiveness of cognitive-behavioral therapy (CBT). Although mental health and substance use problems traditionally have been treated separately--often within different service settings--the field has begun to reach consensus that these conditions should be addressed concurrently. The integration of cognitive-behavioral strategies for both disorders has shown promise for enhancing both substance use and anxiety outcomes. This workshop will focus on identifying and addressing substance use and substance use disorders in the treatment of anxiety disorders.

Learning Objectives

  • Identify substance use and substance use disorders in individuals with anxiety disorders
  • Understand the potential impact of substance use on anxiety symptoms and treatment
  • Integrate behavioral strategies for the management of substance use disorders within anxiety disorder treatment
  • Apply interoceptive and emotional exposure to target overlapping vulnerabilities for anxiety disorders, substance use disorders, and chronic pain
  • A combination of didactic (e.g., instruction, video) and experiential methods will be used. Experiential methods will include the use of small group exercises and role-plays

Implications for everyday clinical practice of CBT
Substance use and substance use disorders commonly co-occur with anxiety disorders. The ability to recognize and address substance use and substance use disorders within the treatment of anxiety disorders may be particularly important to improving outcomes in this population.

Kathryn McHugh is a clinical psychologist at McLean Hospital and an assistant professor at Harvard Medical School. The focus of her research and clinical practice is on enhancing the effectiveness of and access to behavioral therapies. Her current work includes studies of transdiagnostic processes across anxiety disorders, substance abuse, and chronic pain and a clinical trial of cognitive-behavioral therapy for co-occurring anxiety disorders and drug dependence.

References/further reading

  • Ciraulo DA, Barlow DH, Gulliver SB, Farchione T, Morissette SB, Kamholz BW,Knapp CM. (2013). The effects of venlafaxine and cognitive behavioral therapy alone and combined in the treatment of co-morbid alcohol use-anxiety disorders. Behaviour Research and Therapy, 51, 729-735.
  • Mills, K. L., Teesson, M., Back, S. E., Brady, K. T., Baker, A. L., Hopwood, S.,...Ewer, P. L. (2012). Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: a randomized controlled trial. Journal of the American Medical Association, 308, 690-699.
  • Otto, M. W., McHugh, R. K., Simon, N. M., Farach, F. J., Worthington, J. J., & Pollack, M. H. (2010). Efficacy of CBT for benzodiazepine discontinuation in patients with panic disorder: Further evaluation. Behaviour Research and Therapy, 48, 720-727.
 

Emotion Regulation Therapy: An Affect Science Based Approach to Chronic Anxiety and Recurring Depression

Doug Mennin, City University of New York and
David Fresco, Kent State University, USA

Workshop 13 - Full details

Despite the success of cognitive behavioral therapies (CBT) for emotional disorders, a sizable subgroup of patients with complex clinical presentations fails to evidence adequate treatment response.  To address these challenges, contemporary CBTs, focusing on metacognition, mindfulness, and acceptance (e.g., MBCT, ACT, DBT, ABBT, MCT, CFT) have been developed and have begun to show efficacy for complex conditions such as chronic generalized anxiety and major depression. Generalized anxiety and major depressive disorders (often termed “distress disorders”; e.g., Watson 2005) are commonly comorbid and appear to be characterized by temperamental features that reflect heightened sensitivity to underlying motivational systems related to threat/safety and reward/loss. Further, individuals with these disorders tend to perseverate (i.e., worry, ruminate) as a way to manage this motivationally relevant distress and often utilize these self-conscious processes to the detriment of engaging new contextual learning. Emotion Regulation Therapy (ERT) is a theoretically-derived, evidence based, treatment that integrates principles from traditional and contemporary cognitive behavioural treatments (e.g., skills training & exposure) with basic and translational findings from affect science to offer a blueprint for improving intervention by focusing on the motivational responses and corresponding regulatory characteristics of individuals with distress disorders. Open and randomized controlled psychotherapy trials have demonstrated considerable preliminary evidence for the utility of this approach as well as for the underlying proposed mechanisms. In this workshop, attendees will learn to help clients to 1) expand their understanding of anxiety and depression using a motivational and emotion regulation perspective; 2) cultivate mindful awareness and acceptance of sensations, bodily, responses, and conflicting emotions; 3) develop emotion regulation skills that promote a distanced and reframed meta-cognitive perspective; 4) apply these skills during emotion-based exposure to meaningful behavioural actions and associated internal conflicts to taking these actions; and 5) build a plan to maintain gains and take bolder action despite the ending of the therapeutic relationship.

Learning objectives

  • Expand one’s understanding of anxiety and depression using a motivational and emotion regulation perspective
  • Increase familiarity with ERT skills designed to promote mindful awareness and emotion regulation
  • Learn how these skills can be used during emotion-based exposure to meaningful behavioural actions and associated internal conflicts to taking these actions

The training modalities in this Workshop will be lecture, demonstration, skills training, role-play, video

Implications for everyday clinical practice of CBT
Clinicians who attend this workshop will be better able to treat a refractory group of clients (clients with comorbid chronic anxiety/depression, those who are highly “emotional” and continuously perseverate). They will be able to better identify the emotional experiences of their clients and aid clients in doing so “on the spot” in their everyday lives.  They will learn tools to impart to their clients to strengthen abilities to become more flexibly aware of their emotions, to manage them more effectively, and to engage more thoughtful actions as a result of this emotional clarity and regulation. Overall, clinicians will become more comfortable working with a difficult group of clients and feel more confident in engaging with emotions in sessions with these clients.

Over the past fifteen years, Dr. Douglas Mennin has developed an active program of research in clinical trials and basic research into the nature of mood and anxiety disorders. While on faculty at Yale, he was also Director of the Yale and Anxiety Mood Services (YAMS), where he conducted trial research and supervised students in conducting empirically based treatments for refractory cases with mood and anxiety disorders.  Dr. Mennin has conducted a number of studies of the basic physiological mechanisms of generalized anxiety and major depression and has recently been examining the role of worry and rumination in maintaining and exacerbating immunological processes such as chronic inflammation. He has also developed and evaluated an emotion regulation-based intervention for generalized anxiety and depression that was funded through an NIMH R34 mechanism. In a series of open trials and RCTs, this approach has yielded very strong effects in treating typically refractory disorders. Further, this work has identified a number of cognitive, physiological, and neural mechanisms that may mediate symptomatic outcome. He has also recently adapted this approach into a web-based training, which is currently being applied to caregivers of patients with cancer. Dr. Mennin’s role on these projects has been to further develop this emotion-regulation based CBT as well as to train and supervise protocol therapists at the performance sites on both procedures of treatment and assessment. In both applied and basic research, Dr. Mennin has trained numerous graduate students and post- baccalaureate research assistants on diagnostic and physiological assessment and mentored them on the development of independent studies that were routinely presented at national conferences or published.  To date, in addition to publications listed below, this line of work has yielded an authored book with Guilford (Mennin & Fresco, under contract), one of the inaugural “spotlight presentations” at the annual meeting of the Association for Behavioral and Cognitive Therapies, and numerous invited addresses.

David M. Fresco is an associate professor of psychology at Kent State University and adjunct associate professor of psychiatry at Case Western Reserve University School of Medicine. He directs the Psychopathology and Emotion Regulation Laboratory (PERL) and is a Co-Director of the Kent Electrical Neuroimaging Laboratory (KENL). He received his PhD from the University of North Carolina at Chapel Hill and completed a postdoctoral fellowship at Temple University. His program of research adopts an affective science perspective to the study of anxiety and mood disorders. Working at the interface of cognitive behavioural and emotion regulation approaches, he conducts survey, experimental, and treatment research to examine factors associated with major depressive disorder (MDD) and generalized anxiety disorder (GAD) including metacognitive factors (e.g., explanatory flexibility, decentering, rumination, worry), peripheral psychophysiology, and emerging work from affective neuroscience, utilizing neuroimaging and electrophysiological techniques. Another focus of the PERL lab is the development of treatments informed by affective and contemplative neuroscience findings that incorporate mindfulness meditation and other practices derived from Buddhist mental training exercises. Much of Dr. Fresco’s NIH-funded treatment research has focused on the infusion of mindfulness into Western psychosocial treatments. He is presently Associate Editor for two journals, the Journal of Consulting and Clinical Psychology and Cognitive Therapy and Research. He is also a frequent reviewer for the Interventions Committee of Adult Disorders (ITVA) of the National Institute of Mental Health.

References/further reading

  • Fresco, D. M., Mennin, D. S., Heimberg, R. G., & Ritter, M. R. (2013). Emotion Regulation Therapy for Generalized Anxiety Disorder. Cognitive and Behavioral Practice, 20, 282-300. doi:10.1016/j.cbpra.2013.02.00.
  • Mennin, D. S., & Fresco, D. M. (2013). What, me worry and ruminate about DSM-5 and RDoC?: The importance of targeting negative self-referential processing. Clinical Psychology:  Science and Practice, 20, 259-268.
  • Mennin, D. S. & Fresco, D. M. (2014). Emotion Regulation Therapy (pp. 469-490). In J. J. Gross (Ed.) Handbook of Emotion Regulation, 2nd Ed. New York: Guilford Press. 
   

 

Workshop 14 has been cancelled
 

Skills for Psychological Recovery from Trauma

Josef Rusek, VA Palo Alto Health Care System, USA

Workshop 15 - Full details

Skills for Psychological Recovery (SPR) is an intervention that aims to help survivors gain skills to manage distress and cope with post-disaster and post-trauma stress and adversity. SPR skills represent simplified versions of cognitive-behavioral interventions suitable for use by disaster mental health service providers and other helping professionals assisting survivors of recent trauma.  The goals of SPR are to facilitate post-event recovery, support functioning, and prevent behaviors that may maintain or worsen problems. Workshop participants will learn the five main skills of SPR: Building Problem-Solving Skills, tools to break problems down into more manageable chunks, generate a range of ways to respond, and decide what actions to take; Promoting Positive Activities, increasing involvement in meaningful and positive activities; Managing Reactions, stress management tools to better manage distressing physical and emotional reactions; Promoting Helpful Thinking, helping individuals learn how their thoughts influence their emotions, become more aware of what they are saying to themselves, and replace unhelpful with more helpful thoughts; and Building Healthy Social Connections, strengthening support seeking and giving of support to others.

Learning objectives

  • Participants will be able to identify and deliver the 5 core skills included in SPR
  • Participants will become familiar with a range of written educational materials suitable for use in the first weeks and months following exposure to trauma
  • Participants will understand the rationale for selection of SPR skills based on client presentation

Implications for everyday clinical practice of CBT
SPR can be used with a wide range of trauma survivors, and is designed for use in the first weeks and months after trauma exposure.

Dr. Josef Ruzek is Director of the Dissemination and Training Division of the National Center for PTSD in the U.S. Veterans Health Administration. Dr. Ruzek specializes in early intervention to prevent the development of PTSD and co-authored the Psychological First Aid and Skills for Psychological Recovery field guides created jointly by the National Center for PTSD and the National Child Traumatic Stress Network. His current work focuses on dissemination of evidence-based cognitive-behavioral treatments for PTSD and development of Internet- and smartphone-based interventions for trauma survivors. He served as psychotherapy champion for the joint VA-Department of Defense Clinical Practice Guideline for Management of Traumatic Stress and edited two editions of Cognitive-Behavioral Therapies for Trauma as well as Caring for Veterans with Deployment-Related Stress Disorders: Iraq, Afghanistan, and Beyond. Dr. Ruzek is a past member of the Board of Directors of the International Society for Traumatic Stress Studies.

References/further reading

  • Berkowitz, S. Bryant, R., Brymer, M., Hamblen, J., Jacobs, A., Layne, C., Macy, R., Osofsky, H., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., & Watson, P. (2010). The National Center for PTSD & the National Child Traumatic Stress Network, Skills for Psychological Recovery: Field Operations Guide.
  • Forbes, D., Fletcher, S., Wolfgang, B., Varker, T., Creamer, M., Brymer, M. J., Ruzek, J. I., Watson, P., & Bryant, R.A. (2010). Practitioner perceptions of Skills for Psychological Recovery: a training programme for health practitioners in the aftermath of the Victorian bushfires. The Australian and New Zealand Journal of Psychiatry, 44(12), 1105-1111.
  • Ruzek, J. I. (In press).  Community-based early intervention with trauma survivors. Oxford handbook of traumatic stress.
 

How to be a better CBT therapist

Jasper Smits, The University of Texas at Austin, USA    

Workshop 16 - Full details

Although designated as a first-line intervention for depressive and anxiety disorders, CBT is associated with meaningful non-response and attrition rates. Along with other factors, the quality of CBT implementation is fundamental to whether or not CBT is successful for many patients. This workshop provides training in assessing, conceptualizing and remedying “treatment resistance.” Using a complex case example, didactics and group exercises will focus on how to identify and target patient factors (e.g., schemas/core beliefs, motivation), therapist factors (e.g., attitudes, beliefs, self-awareness, treatment delivery) and relationship factors (e.g., therapeutic alliance/collaboration) related to CBT outcome for anxiety and depression. Within this context, this workshop will discuss core CBT strategies (e.g., self-monitoring, cognitive restructuring, behavioral experiments, exposure therapy) and provide instruction on how to integrate exercise interventions with CBT strategies. 

Learning Objectives
•          Conceptualize treatment resistance using a CBT framework
•          Identify strategies for enhancing patient’s engagement in therapy
•          Utilize exercise interventions to optimize CBT outcomes

The training modalities for this Workshop will be didactics, case discussion, group discussion, and role play

References

  1. Clark, D.A. (2013).  Collaborative empiricism: A cognitive response to exposure reluctance and low distress tolerance. Cognitive Behavioral Practice, 20, 445-454.
  1. Otto, M. W., & Smits, J. A. J. (2011). Exercise for mood and anxiety: Proven strategies for overcoming depression and enhancing well-being. New York: Oxford University Press.
  1. Strunk, D. R., Brotman, M. A., DeRubeis, R. J., Hollon, S. D. (2010). Therapist competence in cognitive therapy for depression: predicting subsequent symptom change. Journal of Consulting & Clinical Psychology, 78, 429-437.

Implications for everyday clinical practice of CBT
Treatment resistance and failure are among the greatest challenges therapists face in practice. This workshop aims to help therapists hone their skills to overcome these barriers to achieving the outcomes they and their patients hope to achieve.

Jasper Smits is Professor of Psychology in Department of Psychology and the Institute for Mental Health Research at the University of Texas at Austin. His research and clinical practice focus on the treatment of anxiety and related disorders. Applying a translational method, he is particularly interested in the development of strategies that can augment cognitive and behavioral interventions for these conditions. He is a federally funded investigator and has published over 100 articles, chapters, and books spanning his research interests. He also is a member of the Scientific Council of the Anxiety and Depression Association of America and is a former Beck Institute Scholar at the Beck Institute for Cognitive Therapy and Research.

 

The Treatment and Prevention of Anxiety in Children and Young People

Paul Stallard, University of Bath, UK

Workshop 17 - Full details

It has been estimated that approximately 1 in 5 children will experience an incapacitating episode of anxiety by the time of their eighteenth birthday. Anxiety disorders are persistent and adversely impact upon everyday functioning, academic achievement, peer and family relationships. If left untreated anxiety disorders increase the risk in young adulthood of other problems including depression, illicit drug dependence and educational underachievement.

Empirically supported psychological treatments for anxiety have been developed with Cognitive Behaviour Therapy (CBT) having the strongest evidence base. Meta-reviews suggest that approximately 60% of children will respond to CBT. However comparatively few children with emotional disorders are ever identified with the majority having no contact with specialist mental health services. This has increased interest in preventive approaches designed to teach children skills to remain emotionally resilient 

This workshop will provide an overview of CBT interventions for the treatment and prevention of anxiety disorders which can be used individually and in groups. The key elements of CBT interventions will be presented including formulations, use of assessment measures, psycho-education, emotional management and cognitive enhancement. Materials and exercises used in a recent school based anxiety prevention trial (PACES) will be presented and the implications of the results discussed.    

Learning Objectives

  • Understand the general CBT model for anxiety in children and young people
  • Understand the core components of anxiety prevention and treatment programmes 
  • Develop new ideas for undertaking CBT with children and young people

The workshop will involve formal presentations, group discussions, case summaries, video clips and small group work 

Paul Stallard is Professor of Child and Family Mental Health at the University of Bath and  Head of Psychological Therapies (CAMHS) for Oxford Health NHS Foundation Trust. He has worked with children and young people for over 30 years since qualifying as a clinical psychologist. Clinically, he works within a specialist child mental health team where he leads a Cognitive Behaviour Therapy (CBT) clinic for children and young people with emotional disorders of anxiety, depression, OCD and PTSD. He is the author of “Think Good Feel Good: A cognitive behaviour therapy workbook for children and young people” and Editor of the book series “Cognitive Behaviour Therapy with children, adolescents and families”. He is an active researcher with current research projects including large national multi-site randomised controlled trials evaluating the effectiveness of school based CBT programmes on depression (PROMISE) and anxiety (PACES).

References/further reading

  • Stallard, P. (2002). Think Good - Feel Good: A cognitive behaviour therapy workbook for children and young people. John Wiley. Chichester.
  • Stallard, P. (2009). Anxiety: Cognitive Behaviour Therapy with children, adolescents and families. Routledge. East Sussex.
  • Stallard, P. (2010). Mental health prevention in UK classrooms: the FRIENDS anxiety prevention programme. Emotional and Behavioural Difficulties.  15;1: 23–35
   

 

Workshop 18 has been cancelled

 

 

Cognitively focused treatment of OCD: The paradox of thought control and other cognitive dimensions

Maureen Whittal, University of British Columbia and Vancouver CBT Centre, USA

Workshop 19 - Full details

Behavioural treatments for OCD that involve prolonged exposure to anxiety provoking situations have long been considered the psychological treatment of choice. However, numerous randomized trials established that cognitively focused treatment is equally effacious to the gold standard of exposure and response prevention (ERP). Cognitive treatments appear to be easier to tolerate and are associated with fewer dropouts. Moreover, cognitively focused treatment may be particularly useful in treating people with primary obsessions, who have traditionally achieved less success with ERP.
The purpose of this workshop is to introduce participants to cognitively focused theory and treatment for OCD, and to cognitive assessment measures that focus on areas thought to be important in the etiology and maintenance of OCD. The importance of normalizing unwanted thoughts and identifying interpretations of intrusive thoughts will be emphasized. However, the bulk of the workshop will focus on cognitive strategies to challenge common appraisals, including overimportance of thoughts, need to control thoughts, overestimation of threat and inflated responsibility. Immediate and long-term treatment outcomes from recent randomized trials using this protocol will also be reviewed. If time permits an introduction to mental contamination will be reviewed and components of treatment identified.

Learning Objectives

  • The cognitive model of OCD and its implications for treatment
  • The belief domains thought to be relevant in OCD
  • Strategies to challenge the interpretations of intrusive thoughts

The main methods of training will include verbal instruction, video demonstration and a small group exercise.

Implications for the clinical practice of CBT
OCD is a heterogenous disorder, which can make it difficult to be comfortable treating the various presentations. Familiarization with the phenomenology and cognitive conceptual model will naturally lead to appropriate treatment strategies.

Maureen Whittal is a practicing clinical psychologist in Vancouver, British Columbia. She was involved in the development and testing of cognitive treatments for OCD and has run 3 randomized clinical trials to test the efficacy of the treatment. In 2009 she opened the Vancouver CBT Centre where she works in clinical practice.

References

  • Rachman, S. J. (2006). The fear of contamination: Assessment and Treatment. Oxford University Press.
  • Whittal, M.L., Woody, S.R., McLean, P.D., Rachman, S., & Robichaud, M. (2010). Treatment of obsessions: A randomized controlled trial. Behaviour Research and Therapy, 48, 295-303.
  • Whittal, M.L., Robichaud, M.L., & Woody S.R. (2010). Cognitive therapy of obsessions: Using video components to enhance dissemination. Cognitive and Behavioral Practice, 17, 1-8.