Pre-Conference Workshops

A programme of 17 one-day Workshops will be held on Wednesday 20th July on the day before the Congress. The workshops will begin at 9.30 and finish at 17.00. These workshops, many of them by internationally recognised experts, offer participants an opportunity to develop practical skills in the assessment and treatment of a range of areas. A description of each workshop is given below and you can register online or using the application form included with this programme. The number of places available is limited so early application is advised to avoid disappointment.

 

Adult Mental Health

Workshop 1

Cognitive Processing Therapy for Post Traumatic Stress Disorder
Patricia A. Resick,
National Center for PTSD, Boston University and Curators’ Professor of Psychology, University of Missouri-St. Louis

Workshop 2

New Developments in the Treatment of Bipolar Disorder: The Roles of Behaviour, Cognition and Goal Regulation in Preventing Manic Relapse
Sheri L. Johnson
Department of Psychology, University of Miami

Workshop 3

Recent Developments in the Treatment of Anxiety and Irritable Bowel
Michelle Craske
University of California at Los Angeles, USA

Workshop 4

Schema Therapy for Difficult Patients
Jeffery Young
Schema Therapy Institute, New York, USA

Workshop 5

New Competencies in Trauma Work: Working with Dissociation and Attachment in Complex Trauma
Claudia Herbert
The Oxford Development Centre Ltd, UK

Workshop 6

Developing Clinical Skills in Cognitive Behaviour Therapy for Panic, following the Clark (1986) Model John Manley
West London Mental Health NHS Trust

 
Psychosis
Workshop 7

An Introduction to a Formulation Based Approach to Cognitive Behaviour Therapy for Psychosis
Craig Steel and Ben Smith
University College London, UK

Cancelled

Sampling Experiences in the Flow of Daily Life in Psychosis: Stress, Cannabis and Self-Esteem
Inez Germeys and Cecile Henquet
Maastricht University, the Netherlands

Workshop 9

A Cognitive Approach To Early Intervention in Transitions to Psychosis
Anthony P. Morrison,
University of Manchester
Andrew Gumley
University of Glasgow
Paul French
BSTMHT

 

Clinical and Applied Issues

Workshop 10

Mindfulness-Based Cognitive Therapy: An Introduction Melanie J.V. Fennell
Department of Psychiatry, Oxford University, UK

Workshop 11

Encouraging the Experiential Mind to Communicate with the Conceptual Mind
Ann Hackmann
Oxford University and Institute of Psychiatry, London, UK

Workshop 12

Compassionate Mind Training for Shame and Self-Attacking Inner Dialogues
Paul Gilbert
Mental Health Research Unit, Kingsway Hospital, Derby and
Deborah Lee
Oxford Cognitive Therapy Centre and University College London

Workshop 13

Introduction to Using Acceptance and Commitment Therapy (ACT)
Mark Webster
Intensive Psychological Therapy Service, Dorset Healthcare NHS Trust, UK

 
Eating and Impulse Control
Workshop 14

Working with Multi-impulsivity in the Eating Disorders: A CBT Approach to Formulation and Treatment
Glen Waller
St.George's Hospital Eating Disorders Service, London

 
Behavioural Medicine
Workshop 15

Cognitive Behaviour Therapy for Sleep Disturbance Across Disorders: Moving Beyond the Basics.
Allison G. Harvey
University of California, Berkeley, USA

 
Learning Disabilities
Cancelled

Assessment and Treatment of Anger Problems in People with Intellectual Disabilities
Ray Novaco
University of California, Irvine, USA, and
John Taylor
Northumbria University, Newcastle upon Tyne, UK

 
Children and Adolescents
Workshop 17

Cognitive Behaviour Therapy for Children and Adolescents with Post Traumatic Stress Disorder

David M. Trickey and Lucy Serpell,
Traumatic Stress Clinic, London, UK

 

See below for details of each workshop.

 

Workshop 1

Cognitive Processing Therapy for Post Traumatic Stress Disorder

Patricia A. Resick, National Center for PTSD, Boston University and University of Missouri-St. Louis, USA

The purpose of this workshop will be to train participants in the implementation of cognitive processing therapy (CPT), an evidence-based treatment for PTSD. CPT is a 12-session protocol that has been demonstrated to be effective for the treatment of PTSD and depression resulting from a range of traumatic events and can be implemented as an individual or group treatment. CPT consists of trauma-focused cognitive therapy and writing exposure arranged as a systematic and progressive series of skills and assignments. After an introduction to the theoretical underpinnings of the therapy, participants will learn how to treat clients with CPT session by session.

In addition to didactic information, CPT will be demonstrated with videotaped examples. Common problems encountered with clients will be discussed. Participants are encouraged to bring case examples for discussion.

• Participants will learn how information-processing theory of PTSD leads to specific interventions and how to relay this information to clients to elicit their cooperation with treatment.

• Participants will learn about areas of disruptive thinking most likely to result from trauma.

• Participants will be trained in cognitive interventions that assist the client to challenge distorted thinking and replace these unhelpful thinking patterns with alternative thoughts.

• Participants will be taught to implement a writing form of exposure.

• Participants will learn the CPT protocol and how to adapt it for individual or group treatment.

 

 

Workshop 2

New Developments in the Treatment of Bipolar Disorder: The Roles of Behaviour, Cognition and Goal Regulation in Preventing Manic Relapse

Sheri L. Johnson, Department of Psychology, University of Miami, USA

The goal of this workshop is to review psychological interventions that can be used as supplements to medication treatments for the prevention of mania. A range of empirical research has been conducted on psychological treatments for bipolar disorder. This workshop will draw on that research, as well as recent innovations in psychosocial treatment for bipolar disorder, to cover three basic areas: improving symptom awareness, challenging manic cognition, and enhancing goal regulation. Clinicians will learn strategies that will help them intervene with bipolar disorder.

This workshop will begin with basic approaches for enhancing awareness of manic symptoms and motivation to address those symptoms. These strategies include mapping symptoms and their consequences using a life chart, personalized approaches to symptom monitoring, and developing emergency management plans.

Then, workshop participants will learn about the state of evidence for current cognitive-behavioral interventions and the basic research evidence about cognition and mania. Key interventions designed to help address manic cognition will be reviewed, and issues in challenging cognitions that might be ego-syntonic will be discussed.

Finally, preliminary work focused on developing a goal regulation intervention for bipolar disorder will be described, with examples of the treatment targets and strategies.

Dr. Johnson is an Associate Professor at the University of Miami who has conducted research on the course of mania for more than a decade. Her work has been funded by the National Institute of Health and the National Alliance for Research for Schizophrenia and Depression. She has published over 60 articles and chapters and is currently editing her fourth book. In her more recent work, she has begun to develop a psychosocial intervention that draws on basic research on goal regulation.

Key references:

Leahy, R. L. (2004). Cognitive Therapy. In S L. Johnson & R. Leahy (Eds.), Psychosocial Approaches to Bipolar Disorder. (pp. 139-161). New York, NY: Guilford Press. This provides a quick overview of some of the basic cognitive therapy approaches in bipolar disorder.

Johnson, S. L. (2005). Goal regulation and mania: A review. Clinical Psychology Review, 25, 241-262.

 

Workshop 3

Recent Developments in the Treatment of Anxiety and Irritable Bowel Syndrome

Michelle Craske, University of California at Los Angeles, USA

This workshop will cover several different topics. The morning session will focus on a fear-based model for irritable bowel syndrome, and a step by step description of a treatment designed to lessen conditioned fears and pain, cognitive misappraisals, and maladaptive behaviours associated with visceral sensations. Second, optimal ways for violating threat relevant outcome expectancies during behavioural exposures for anxiety disorders will be discussed, with attention to our recent data indicating the value of sustained excitation throughout exposure, and the value of exposure durations that exceed the duration at which the feared outcome is judged to be extremely likely to occur. Finally, a unified model of cognitive behavioural therapy for anxiety disorders will be presented, with attention given to threat domain specific versus shared process treatment orientation

 

Workshop 4

Schema Therapy for Difficult Patients

Jeffery Young, Schema Therapy Institute, New York, USA

Dr. Young will present a state-of-the-art treatment he has pioneered - Schema Therapy-designed specifically for working with personality disorders and other challenging cases in a systematic, focused manner. Schema therapy is a significant expansion of cognitive therapy that blends cognitive-behavioral techniques with strategies drawn from attachment theory, emotion-focused therapy, object relations, and psychodynamic therapies.The approach has been utilized with a broad range of difficult-to-treat disorders, such as: personality disorders, chronic depression and anxiety, substance abuse, and relationship difficulties. Schema Therapy more fully explores the client's childhood history; uses imagery and other emotion focused techniques extensively in treatment; examines self-defeating life patterns; and places a great deal of emphasis on the therapy relationship.

Participants will learn to conceptualise challenging patients within this framework, to implement specific skills for assessment and treatment, and to overcome obstacles to progress rapidly. (In this workshop, Dr. Young will emphasize strategies that are applicable to a broad range of chronic adult cases, rather than focusing on specific diagnoses, such as the borderline patient). Some of these techniques include: schema flashcards, schema dialogues, the Young Schema Questionnaire, imagery work, limited reparenting, and behavioural pattern-breaking.

The workshop will make extensive use of videotaped patient segments to illustrate interventions. In addition, participants will receive a packet with assessment and treatment handouts, which they can reproduce and begin utilizing immediately in clinical and research work.

Dr. Young is Founder and Director of the Cognitive Therapy Centers of New York and Connecticut, and the Schema Therapy Institute. He is also on the faculty in the Department of Psychiatry at Columbia University. Dr. Young completed a postdoctoral fellowship at the Center for Cognitive Therapy at the University of Pennsylvania with Dr. Aaron Beck, and went on to serve as Director of Research and Training. He is the founder of Schema Therapy, an integrative approach for personality disorders and treatment-resistant patients and has published widely in the fields of both cognitive and schema therapies, including two major books: Schema Therapy: A Practitioner's Guide, written for mental health professionals, and Reinventing Your Life, a popular self-help book based on schema therapy.

 

Workshop 5

New Competencies in Trauma Work: Working with Dissociation and Attachment in Complex Trauma

Claudia Herbert, The Oxford Development Centre Ltd, UK

In recent years, the field of trauma therapy has hugely expanded with new research emerging all the time. As a result, it is becoming increasingly apparent that in order to be effective with clients in this field, we have to widen our understanding to consider findings from a variety of different disciplines, such as, for example, cognitive science, neurobiology, developmental psychology, information-processing theories, rather than sticking to more narrowly defined approaches of the past. Excitingly, with this expansion in knowledge, a number of therapeutic factors are emerging, which seem important to be considered in the context of CBT-based work with complex trauma. This workshop will focus especially on two therapeutic factors, attachment and dissociation. Firstly, the theoretical framework underpinning the importance of the concept of attachment as a foundation for the development of healthy neurobiological functioning and subsequent social learning, which is carried right into adulthood, will be explored. Secondly, problems in attachment style and potential consequences in terms of a person’s later functioning will be explored, including the development of certain Personality Disorders. Thirdly, the concept of dissociation as a classically conditioned response to maintain functioning in response to trauma (theory of structural dissociation, Niejenhuis, et al., in press) will be proposed. The workshop will introduce a CBT-based therapeutic framework and clinical techniques ( Herbert, 2002), aimed at helping adult clients repair deficits in their early attachment relationships and reducing the maintenance of structural dissociation in order to achieve eventual integration of the different parts of personality into one unique Self. Examples from clinical practice and the opportunity for some self-reflective learning will be provided for workshop participants.

Objectives for this workshop are to introduce participants to 1) the concepts of attachment and dissociation, 2) a CBT-based therapeutic framework for working with complex trauma and 3) clinical techniques that help repair deficits in early attachment relationships and enable clients to reduce the maintenance of dissociation.

Dr Claudia Herbert, BSc, MSc, DClinPsy, AFBPsS is a UKCP Registered CBT Psychotherapist and the Founder Director of The Oxford Development Centre Ltd., incorporating Oxfordshire s Independent Psychology Service and The Oxford Stress and Trauma Centre. Among many other interests, she is a specialist in trauma psychology, for both, Type I and Type II trauma, has presented at conferences worldwide and published a number of academic articles and two books

Herbert, C. (2002) - A CBT-based therapeutic alternative to working with complex client problems, European Journal of Psychotherapy, Counselling and Health, 5, 2, 135-144.

 

Workshop 6

Developing Clinical Skills in Cognitive Behaviour Therapy for Panic, following the Clark (1986) Model

John Manley, West London Mental Health NHS Trust, London, UK

In comparison with other disorders, patients with Panic and agoraphobia have been out of the limelight. It is thought to be an area where the model and treatment is known. However, I believe there is a deeper level of detail to be learnt in applying the essential skills in this work. I also cover developments in CBT for other disorders that apply to work with panic. Work with chronic panic and agoraphobia brings in tackling personality and lifestyle complications that impact on the therapeutic relationship and in applying the model for panic.

To understand the Clark (1986) model of panic. This includes the role of safety seeking behaviours, hypervigilance and avoidance. To focus on the cognitive aspects of treatment. To look at techniques from other disorders, such as imagery work and imaginal exposure to traumatic memories, and how these can be useful with panic. To be aware of common problems in work with chronic panic and agoraphobia and some strategies to approach these.

Learning Objectives: To be able to draw out the model;To be able to set up behavioural experiments in treatment; Use of metaphors in treatment; How to address common problems.

John Manley is a Consultant Clinical Psychologist. After gaining the Oxford diploma in Cognitive Therapy, he worked for three years as an Honorary Lecturer at the Institute of Psychiatry and as a clinician at the specialist Centre for Anxiety Disorders and Trauma at the Maudsley Hospital, specialising in Panic and agoraphobia, Social Phobia and PTSD. He has presented numerous workshops, including at the Institute of Psychiatry and at the European Association of Behavioural and Cognitive Psychotherapy. He is currently Head of Adult Psychology, Hammersmith & Fulham, West London Mental Health NHS Trust

Key references

Clark, D.M. (1996) Panic Disorder: From Theory to Therapy. Ch 15 in Frontiers of Cognitive Therapy, Ed P Salkovskis, Guilford, New York, Guilford Publications.

Hackmann, A. (1998) Cognitive Therapy for Panic and Agoraphobia: working with complex cases. Ch 2 in Ed. N. Tarrier, A. Wells, & G. Haddock, Treating Complex Cases: The Cognitive Behavioural Therapy Approach: Wiley, Chichester.

Wells, A. (1997) Cognitive Therapy of Anxiety Disorders. Wiley, Chichester.

 

Workshop 7

An Introduction to a Formulation Based Approach to Cognitive Behaviour Therapy for Psychosis

Craig Steel & Ben Smith, University College London, UK

There has recently been considerable growth in both the theoretical basis of CBT for psychosis, alongside the need for more practitioners within services. However, it is common and understandable for clinicians to feel hesitant and under-confident when attempting to implement such an approach.

The main aim of this workshop is to de-mystify CBT for psychosis and to show clinicians how their existing skills in CBT assessment, formulation and treatment can be readily adapted for use with this client group. Our approach (based on the model of Garety et al., 2001) emphasises the use of an individualised formulation in order to attempt to make the content of the symptoms of psychosis become ‘understandable’. Appropriate interventions will then evolve out of the formulation, as within CBT for other disorders.

The workshop is aimed at individuals from all professions who work with people diagnosed with psychosis. Some CBT knowledge would be helpful, though this only needs to be basic. One aim of the workshop is to enable workers to understand/formulate the symptoms of psychosis from a new perspective, and for this understanding to facilitate a working relationship with clients, even if therapeutic interventions are not employed.

Thus the workshop is open to non-therapists.

Learning objectives

  1. To develop a good understanding of the cognitive model of psychosis
  2. To learn how to conduct a CBT assessment for psychosis
  3. To develop skills in formulating psychotic symptoms guided by the model
  4. To understand issues of engagement in working using CBT for psychosis
  5. To learn how to share formulations and develop collaborative interventions

The workshop is suitable for anyone with a good understanding of cognitive-behavioural theory and therapy and who is enthusiastic to learn more about applying their existing knowledge to psychosis.

Craig Steel and Ben Smith are both research clinical psychologists currently involved in an RCT aimed at evaluating both CBT and family interventions in reducing relapse rates in psychosis (PRP trial, grantholders: P.Garety, E. Kuipers, D. Fowler, P. Bebbington). Both have been involved in research, training and supervision of CBT for psychosis, alongside clinical practice for a number of years.

References

Fowler, D., Garety, P.A. & Kuipers, E. K. (1995). Cognitive Behaviour Therapy for Psychosis: Theory and Practice. John Wiley: Chichester.

Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D. & Bebbington, P.E. (2001). A cognitive model of the positive symptoms of psychosis, Psychological Medicine, 31, 189-195.

 

Workshop 8

Sampling Experiences in the Flow of Daily Life in Psychosis: Stress, Cannabis and Self-Esteem - Cancelled

Inez Germeys and Cecile Henquet, Maastricht University, the Netherlands

People are constantly interacting with the world: the context influences every aspect of human behaviour. Therefore, especially in the realm of mental health, it becomes essential to investigate person-environment interactions. The Experience Sampling Method (ESM) is a structured diary technique which is used to study subjects in their daily life. It employs a random time sampling strategy to assess mental state and the context in which it is embedded, in the natural flow of daily life. ESM has been used successfully to study fluctuations in symptoms in patients with psychosis in relation to several environmental exposures such as stress and cannabis.

Not only does this method provide insight in the underlying mechanisms and course of psychosis, but it also aides the clinicians in formulating therapeutic options in individual cases.

The main objective of the workshop is to introduce participants to this type of momentary assessment methodology. We will position and study innovative research techniques that contribute to the study of the dynamics of 'hidden' experiences in psychiatry as they occur in normal daily life challenges. An overview of the most recent findings of applications of ESM in psychosis research, with an emphasis on stress reactivity, self esteem and acute effects of cannabis exposure in daily life, will be presented.

The workshop is open to a multidisciplinary audience consisting of clinical and fundamental researchers, working in clinical practice, industry or at research centres including universities.

Dr. Inez Myin-Germeys, lecturer, works as a post-doc researcher at Maastricht University, Department of Psychiatry and Neuropsychology. The main focus of her work concerns person-environment interactions in psychosis and the development of dynamical psychological models of the psychosis phenotype.

Cécile Henquet, research psychologist, works as a PhD-student at Maastricht University, Department of Psychiatry and Neuropsychology. The subject of her study is genotype-environment interactions within the cannabis-psychosis relationship in daily life.

Key References:

Myin-Germeys, I., J. van Os, et al. (2001). Emotional reactivity to daily life stress in psychosis. Arch Gen Psychiatry 58: 1137-44.

Myin-Germeys, I., P. Delespaul, et al.(2003). The Experience Sampling Method in psychosis research. Current Opinion in Psychiatry 16, sup 2: 33-38.

Van Os, J., Delespaul, P. (2003). Psychosis Research at Maastricht University, The Netherlands. British Journal of Psychiatry 183, 559-560.

 

Workshop 9

A Cognitive Approach To Early Intervention in Transitions to Psychosis

Anthony P. Morrison, University of Manchester, Andrew Gumley, University of Glasgow, Scotland

Paul French, BSTMHT, UK

This workshop will briefly outline the rationale for early intervention in relation to both the development of psychosis and relapse within psychosis, and then consider the role of CBT in early intervention and in the prevention of psychosis. It will outline a cognitive approach to the understanding psychotic symptoms and consider how this approach can be utilised to develop case formulations and inform intervention strategies for prevention of first episodes and relapse. Central to this approach is the normalizing of psychotic experiences and decatastrophising the interpretation of these experiences. The workshop will also consider the impact that such approaches can have on service users quality of life.

The workshop will use a variety of techniques including teaching, discussion, role play and video demonstration to illustrate how this model can be used to develop idiosyncratic case formulations with patients and how such formulations guide intervention. Specific issues including case finding, engaging patients, use of behavioural experiments, and identifying and challenging interpretations (particularly of impending madness and relapse); safety behaviours and metacognitive beliefs will be examined in detail. The workshop will assume some knowledge of and basic skills in cognitive therapy.

Participants should be able to:

  • Understand the rationale for early intervention and the use of CT for people at risk of psychosis and people at risk of relapse
  • Develop case formulations based on a cognitive model
  • Select treatment strategies based on such formulations

Tony Morrison is a Reader in Clinical Psychology at the University of Manchester and is also a Consultant Clinical Psychologist in a specialist programme of care for people with early psychosis in Salford and Trafford. Dr Gumley is a Senior Lecturer in Clinical Psychology at the University of Glasgow. Paul French is a Cognitive Therapist and coordinates an early detection and intervention service for people at risk of psychosis. All workshop leaders have published a number of articles on cognitive therapy for psychosis and experimental studies of cognitive processes in psychosis, and have been involved in treatment trials for cognitive therapy for psychosis and the prevention of psychosis.

References:

French, P. & Morrison, A.P. (2004) Cognitive therapy for people at high-risk of developing psychosis. London: Wiley.

Gumley, A. I. et al. (2003). "Early intervention for relapse in schizophrenia: results of a 12-month randomised controlled trial of cognitive behaviour therapy." Psychological Medicine 33: 419-431.

Morrison, A.P. et al. (2003) Cognitive Therapy for Psychosis: A Case Formulation Approach. Brighton: Psychology Press.

 

Workshop 10

Mindfulness-Based Cognitive Therapy: An Introduction

Melanie J.V. Fennell, Department of Psychiatry, Oxford University, UK

The purpose of the workshop is to provide an introductory taste of Mindfulness-Based Cognitive Therapy (MBCT). MBCT was developed with a view to finding a cost-effective method of reducing relapse and recurrence for people vulnerable to recurrent depression. It is based on the observation that, with repeated episodes, depression appears to become increasingly independent of environmental stressors and increasingly likely to be triggered by relatively small, normal changes in mood and the patterns of negative thinking that swiftly follow them. Research has shown that, when low mood is induced in people who have recovered from depression, negative thoughts and assumptions otherwise invisible in recovery begin to emerge. Our own research had confirmed this finding, and in addition identified processes that may be specific to suicidality (hopelessness and disruption of problem-solving skills).

Two clinical trials have now demonstrated the effectiveness of MBCT in reducing the likelihood of relapse by about 40-50% in people who have suffered 3 or more previous episodes of depression. This is broadly comparable to the effect of full-blown cognitive therapy for depression. MBCT is based on Jon Kabat-Zinn's Stress Reduction programme at the University of Massachusetts Medical Centre which was developed to help people suffering chronic physical pain and disease. It combines mindfulness meditation techniques with elements of cognitive therapy, delivered through an 8-week course of classes together with daily homework practice. It is designed to help people to alter their relationship to their own thoughts, feelings and body sensations, so that they learn to approach these with interest, curiosity and compassion, and to see them as passing events with which they can choose to engage (or not), rather than as 'truth' or 'me'. Participants develop the capacity to allow distressing emotions, thoughts and sensations to come and go, without feeling that they have to suppress them, avoid them, elaborate them through rumination, or do battle with them. They identify their own personal relapse signatures, with a view to using what they have learned to nip future depressions in the bud. MBCT is now being further developed in Oxford by a research team led by Professor Mark Williams,to help those who have been through crises in which they have felt suicidal and/or attempted suicide.

Objectives: During the workshop, participants will experience of a range of mindfulness practices. After a brief introduction outlining the rationale for the approach, participants will be offered the opportunity directly to experience mindfulness meditation practices. There will be opportunities for reflection on their experiences, and for discussion.

The workshop is designed for people who are already familiar with cognitive therapy for depression, and would like to explore the possibility of embarking on this new approach.

Workshop Leader: Melanie Fennell was one of the pioneers of cognitive therapy for depression in the UK, and is a founder member of the Oxford Cognitive Therapy Centre. She has worked in research groups at the University of Oxford developing psychological treatments for a range of emotional disorders. She developed the highly successful Oxford Diploma in Cognitive Therapy, and is now Director of a new Diploma/MSc in Advanced Cognitive Therapy Studies. In 2002, she was voted "Most Influential UK Female Cognitive Therapist" by the membership of the BABCP.

She is now working with Professor Mark Williams, developing MBCT for use with recurrent depression and suicidality.

References:

Segal, Z.V., Williams, J.M.G. & Teasdale, J.D. (2002). Mindfulness-Based Cognitive Therapy for depression: A new approach to preventing relapse. Guilford, New York.

Ma, J. & Teasdale, J.D. (2004) Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31-40.

Teasdale, J.D., Segal, Z.V., Williams, J.M.G. et al. (2000) Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615-623

 

Workshop 11

Encouraging the Experiential Mind to Communicate with the Conceptual Mind

Ann Hackmann, Oxford University and Institute of Psychiatry, London, UK

In this workshop we will explore the widely held view that there are at least two ways of knowing things, and two ways of remembering them. It will be suggested that there is a difference between knowing things with the head and with the heart, Methods for exploring the contents of the experiential mind will be discussed. Once these meanings have been examined various methods of bringing emotion into line with logic will be considered. There will be three main sections to the workshop: using behavioural experiments to test the predictions of the experiential mind; banishing toxic meanings which are the ghosts of past trauma; and using metaphor and symbol to transform meanings. All the work will be discussed within the framework of cognitive therapy.

This workshop should offer something of interest to most practitioners, but those with an intermediate expertise in cognitive therapy may benefit most. Attempts will be made to address the cognitive processes underlying the techniques, and to draw out common processes implicit in various therapeutic procedures.

Learning Objectives: To understand the differences between two types of "mind" and two types of memory. In addition, to appreciate the research and theory behind these ideas. To review the concept of cognitive-emotional processing, and consider methods of bring this about. To learn about methods of evaluating shifts in meaning and emotion, and other signs of emotional processing. In addition, methods of working with images, memories and metaphor will be reviewed, demonstrated and practiced.

Ann Hackmann works at the Institute of Psychiatry in London, and at Oxford University. She has been employed for many years on Wellcome Trust grants, to improve the understanding of anxiety disorders, and their treatment with cognitive therapy. Her special interest is in PTSD, and imagery and its relationship to memory.

Key references

Holmes, E. and Hackmann, A. (2004) Mental Imagery and Memory in Psychopathology. (Special Issue) Memory.12, 385-386

Hackmann, A. (1998) Working with images in clinical psychology. In A.S.Bellak & M. Hersen(Eds) Comprehensive Clinical Psychology, 6, 14, 301-318.

 

Workshop 12

Compassionate Mind Training for Shame and Self-Attacking Inner Dialogues

Paul Gilbert, Mental Health Research Unit, Kingsway Hospital, Derby and Deborah Lee, Oxford Cognitive Therapy Centre and University College London, UK

Shame and inner self-criticism/attacking is associated with a range of psychological difficulties, particularly those relating to long-standing issues of self-worth. These are often underpinned by shame and self-dialogues that are highly self-critical/condemning. This workshop will use social mentality theory to explore the nature of shame based, negative self-evaluations. It is suggested that self-criticism often takes the form of inner dialogues and operates as an internal hostile-dominant/fearful/subordinate relationship. This workshop will describe how to conduct a functional analysis of self-criticism, exploring self-attacking as a form of safety behaviour. Participants will learn how to work with these inner dialogues using cognitive-emotional and imagery techniques. A care focused social mentality, that is sensitive to well-being, distress and nurturing, can be elicited and fostered as an alternative self-to-self relating style. People can learn to compassionately re-focus, re-evaluate and re-attribute.

A powerful aid to the development of inner compassion is via imagery and the generation of compassionate feelings for the self. In this workshop participants will have the opportunity to practice compassionate imagery, including the generation of images of ‘the perfect nurturer’.

At the end of the workshop participants will have insight into the complexity and functions of self-attacking, and will be able to formulate the role of safety behaviours and shame in maintaining self-attacking. They will have some experience in using compassionate mind techniques for the development of self-soothing strategies, which help emotional regulation.

Background reading

1. Gilbert, P. (2000) Social mentalities: internal 'social' conflicts and the role of inner-warmth and compassion in cognitive therapy. In P.Gilbert & K.G. Bailey (Eds). Genes on the Couch: explorations in evolutionary psychotherapy. London: Brunner-Routledge.

2. Gilbert, P. & Irons, C. (In press) Therapies for shame and self-attacking, using cognitive, behavioural, emotional imagery, and compassionate mind training. In P. Gilbert (Ed) Compassion: Conceptualisations research and use in psychotherapy. London: Brunner-Routledge. Lee, D. (In press)

3. The perfect nurturer. A model to develop a compassionate mind within the context of cognitive therapy. In P.Gilbert (Ed). Compassion: Conceptualisations research and use in psychotherapy. London: Brunner-Routledge.

 

Workshop 13

Introduction to Using Acceptance and Commitment Therapy (ACT)

Mark Webster, Intensive Psychological Therapy Service, Dorset Healthcare NHS Trust, UK

Acceptance and Commitment Therapy (ACT) is based on the idea that psychological suffering is usually caused by experiential avoidance, cognitive entanglement, and the resulting failure to take needed behavioural steps in accord with core values. According to this view, trying to change difficult thoughts and feelings as a means of coping might can be relatively unhelpful, but new, powerful alternatives are available, including acceptance, mindfulness, cognitive defusion, values, and committed action. Research seems to be showing that these methods are beneficial for a broad range of clients. ACT teaches clients and therapists alike how to alter the way difficult private experiences function mentally rather than having to eliminate them from occurring at all. This empowering message has been shown to help clients cope with a wide variety of clinical problems, including depression, anxiety, stress, substance abuse, and even psychotic symptoms. The benefits are as important for the clinician as they are for clients. ACT has been shown empirically to quickly alleviate therapist burn-out. This one-day workshop will discuss and demonstrate ACT processes and techniques, particularly acceptance, cognitive defusion, and behavioural commitment strategies. Data supportive of this approach will be described. The intention of the workshop is to provide clinicians with an introduction to ACT, a beginning set of skills, and with personal experiences that will direct further development of these skills.

Attendees will learn, at an introductory level:

  • Why experiential avoidance and cognitive fusion underlie most forms of psychopathology
  • How to formulate clinical problems in terms of experiential avoidance and cognitive fusion
  • The major processes and steps in Acceptance and Commitment Therapy
  • How ACT is based on a psychological flexibility model of health
  • How to foster psychological acceptance
  • How to quickly reduce the impact of negative thoughts
  • How to mobilize and make use of the spiritual side of clients
  • How to help clients get more into contact with their core values
  • How to apply these same methods to themselves and to the stressful impact of working with difficult clients

Mark Webster is a psychotherapist working at the Intensive Psychological Therapy Service (IPTS) in Poole, Dorset and in private practice. Initially he worked in the computer industry before retraining in 1990 as a clinician. His initial work was in the field of addictions and then later specialising in Personality Disorders. He was a founding member of the Dialectical Behaviour Therapy (DBT) team at IPTS in 1997 and started integrating ACT into the service from 1999. He works privately in addictions running ACT based programs and, also, developing training in ACT. He has been a Buddhist for over 15 years and teaches a Mindfulness Based Stress Reduction (MBSR) course that uses meditation techniques to help patients with chronic pain.

Recommended Readings:

Hayes, S. C., Strosahl, K, & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behaviour change. New York: Guilford Press.

Hayes, S. C., Wilson, K. G., Gifford, E. V.. Follette, V. M.. & Strosahl, K. (1996). Emotional avoidance and behavioural disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152-1168

 

Workshop 14

Working with Multi-impulsivity in the Eating Disorders: A CBT Approach to Formulation and Treatment

Glen Waller, St.George's Hospital Eating Disorders Service, London, UK

Multi-impulsivity is found in a substantial proportion of eating-disordered patients, particularly in specialist settings. It involves the comorbid presence of a range of other self-damaging behaviours (e.g., self-harm, substance abuse), with the common theme of emotional regulation. This workshop will focus on understanding and treating multi-impulsive cases in the eating disorders, although the methods could be applied to multiimulsivity as found in other settings (e.g., alcohol abuse).

In the first part of the workshop, the common and unique functions of these behaviours will be considered, to explain why they co-exist in many patients. This will be done within a broad cognitive-behavioural formulation framework, including both disorder-specific and schema-level cognitions, emotions and physiological factors. Experiences that might lead to such behaviours are considered, including specific forms of trauma and more general childhood experiences of growing up in an invalidating environment. Examples of case formulations will be discussed, and participants will be encouraged to develop formulations for cases who they have treated.

The remainder of the workshop will consider the cognitive-behavioural treatment of such cases, drawing on a variety of approaches. These will include level 1 interventions (those designed to help the individual to avoid using the behaviours, such as elements of dialectical behaviour therapy), and level 2 interventions (those designed to reduce the need for the behaviours, such as disorder-specific CBT and schema-focused CBT). Relationship and process issues in therapy will also be considered.

Learning objectives:

  • Identification of functions of impulsive behaviours
  • Development of CBT skills for treating multi-impulsivity

Glenn Waller is a clinical psychologist, with over 15 years experience of working with the eating disorders. He runs the multidisciplinary outpatient arm of the St. George's Eating Disorders Service, and leads the CBT team working with this population. He has published widely in the eating disorders

Key references:

Fichter, M., Quadfleig, N., & Reif, W. (1994). Course of multi-impulsive bulimia. Psychological Medicine, 24, 591-604.

Lacey, J. H. (1993). Self damaging and addictive behaviour in bulimia nervosa. A catchment area study. British Journal of Psychiatry, 163, 190-194.

Welch, S. L., & Fairburn, C. G. (1996). Impulsivity or comorbidity in bulimia nervosa. A controlled study of deliberate self-harm and alcohol and drug misuse in a community sample. British Journal of Psychiatry, 169, 451-458.

 

Workshop 15

Cognitive Behaviour Therapy for Sleep Disturbance Across Disorders: Moving Beyond the Basics.

Allison G. Harvey, University of California, Berkeley, USA

"Just as night follows day, so does sleep disturbance follow psychological disturbance" (p. 133, Spielman & Glovintz, 1997) Sleep disturbance is a feature of a wide range of psychological disorders and longitudinal research indicates that insomnia significantly heightens the risk of developing depression, an anxiety disorder or a substance-related problem (Breslau et al., 1996; Ford & Kamerow, 1989) and is a prodrome for relapse in bipolar disorder (Lam et al., 1999). The widely held view among many researchers/clinicians is that the sleep disturbance is secondary to, or an epiphenomenon of, a ‘primary’ medical or psychological disorder. However, evidence is accruing to suggest that sleep disturbance often contributes to the cause and maintenance of other disorders and that it needs to be a specific target of intervention. Accordingly, the aim of this workshop is to highlight to relevance of advances in knowledge on the treatment of chronic insomnia to other psychological disorders also characterized by sleep disturbance.

Topics to be covered in the first half of the workshop include:

  1. The function of sleep
  2. Diagnosing sleep disorder
  3. The assessment of sleep disturbance across disorders
  4. Cognitive behaviour therapy for insomnia (CBT-I) and its evidence base
  5. Cognitive case conceptualization for clients with insomnia
  6. How to reverse cognitive and behavioural maintaining processes

Topics to be covered in the second half of the day include:

The implications of the material covered in the first part of the day for insomnia that is comorbid with another psychological disorder. The disorders covered during this part of the workshop will be guided, to some extent, by the interests of the participants but are likely to include bipolar disorder, chronic pain, substance abuse and the anxiety disorders, especially PTSD. A key issue that we will face together in this section is: What do we do in therapy when there is not yet an evidence base?

This workshop is for clinicians who have basic experience in the use of CBT and are interested in learning new ways of conceptualising and managing primary insomnia and insomnia that is secondary to another psychological disorder. However, students and people hoping to pursue clinical training are also welcome.

Allison Harvey is has recently joined the clinical psychology faculty at the Department of Psychology, University of California, Berkeley. She has spent the past six years working at the Department of Experimental Psychology and Psychiatry, at the University of Oxford, where she directed and worked as a therapist on a study testing the efficacy of a new cognitive therapy treatment for chronic insomnia. A key focus of her current work is to develop better treatments for patients who suffer from sleep disturbance across disorders.

Key references.

Harvey, A.G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40, 869-893.

Horne, J. (1988). Why we sleep: The functions of sleep in humans and other mammals. Oxford: Oxford University Press.

Morin, C.M. & Espie, C.A. (2003). Insomnia: A clinical guide to assessment and treatment. New York: Guildford Press.

 

Workshop 16

Assessment and Treatment of Anger Problems in People with Intellectual Disabilities - Cancelled

Ray Novaco, University of California, Irvine, USA, and John Taylor, Northumbria University, Newcastle upon Tyne, UK

Population surveys have shown aggressive behaviour to be a particular concern for people with intellectual disabilities. The prevalence of aggression has been reported to be between 10% and 40% depending on the setting. It is the main reason for people in this client group to be admitted and re-admitted to institutions and to be prescribed anti psychotic medication. The relationship between anger and aggression has been well established. Further, it has been demonstrated that anger control problems are highly predictive of physical aggression in psychiatric, forensic and intellectual disability service settings.

The research evidence to support psychological treatment of anger problems in people with intellectual disabilities is still developing. There are, however, some significant indications of successful interventions using systematic treatment approaches described by protocol. Recent work by a number of researchers has shown that cognitive-behavioural therapies can be effective in treating a range of clinical conditions experienced by people with intellectual disabilities.

This workshop is based on work that has been carried out in recent years at Northgate Hospital in Northumberland, part of a specialist NHS disability Trust. An in-patient population was assessed on a range of anger and aggression measures in order to investigate the nature and scope of anger problems in this client group. Based on these assessments a sample from this population with clinically severe anger problems took part in a controlled trial of a modified cognitive-behavioural anger treatment based on Novaco's original anger treatment protocol. The workshop briefly reviews the relevant literature in this field, considers the assessment issues in working with this client group, and, using case study material, works through content, process and evaluation issues in applying a cognitive-behavioural approach with reference to a newly developed anger treatment protocol.

The workshop will help participants have a better understanding of the following:

  1. The prevalence and nature of anger and aggression in populations of people with intellectual disabilities.
  2. The interrelationship of anger and aggression and the evidence for the effectiveness of cognitive-behavioural anger treatment approaches.
  3. The importance of robust assessment of anger problems in developing good formulations and treatment plans for individual clients.
  4. The value of delivering a well-evaluated anger treatment protocol to alleviate the problems associated with poor anger control in clients with individual disabilities.

Ray Novaco is Professor of Psychology and Social Behavior at the University of California, Irvine, USA. Cognitive-behavioural therapy for anger was pioneered by Ray Novaco. Funded by the MacArthur Foundation Research Network on Mental Health and the Law, he developed new procedures for anger assessment for use with mentally disordered persons, which are here being extended to the intellectual disabilities field. In addition to being programme consultant for the Northgate Hospital anger project, he serves as research consultant to The State Hospital in Scotland and for many years served on the Advisory Board of Atascadero State Hospital in California.

John Taylor is Professor of Developmental Disability Psychology at Northumbria University, Newcastle upon Tyne, and Head of Psychological Therapies & Research and Consultant Clinical Psychologist with Northgate & Prudhoe NHS Trust, Northumberland, UK. Since qualifying as a clinical psychologist he has worked mainly in intellectual disability and forensic services in community, medium secure, special hospital and prison settings in the UK. In recent years he has published work related to his anger treatment interests in a range of research and professional journals.

Key References:

Novaco, R. W. & Taylor, J. L. (2004). Assessment of anger and aggression in male offenders with developmental disabilities. Psychological Assessment, 16, 42-50.

Taylor J.L. & Novaco, R.W. (2005). Anger treatment for people with developmental disabilities: A theory, evidence and manual based approach. Chichester: Wiley.

Taylor, J. L., Novaco, R. W., Gillmer, B. & Thorne, I. (2002). Cognitive-behavioural treatment of anger intensity in offenders with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 15, 151-165.

 

Workshop 17

Cognitive Behaviour Therapy for Children and Adolescents with Post Traumatic Stress Disorder

David M. Trickey and Lucy Serpell, Traumatic Stress Clinic, London, UK

Ehlers and Clark (2000) provide a comprehensive cognitive model for understanding PTSD in adults. Meiser-Stedman (2002) has considered the application of the model to children. This framework will be used to consider PTSD in children and families, with particular reference to developmental and systemic aspects.

Using this model, methods for intervening at various levels of the system in which traumatised young people find themselves will be presented. The evidence available indicates that exposure of some description is an important component of treatment for PTSD symptoms (Cohen et al. 2000). This means that clients generally need to ‘remember’, before they can ‘forget’. The ethical and clinical dilemma of encouraging young people to do something that they do not want to do, will be considered in the context of the inevitable power imbalance that exists between client and clinician. How can a clinician be persuasive without being coercive and respect a client’s fears without colluding with them? This has important implications for how the rationale for treatment is explained to clients, and their fully informed consent is subsequently gained. The risks of ‘re-traumatising’ will be discussed and thought will be given to how this might be avoided.

Parents and other significant people in children’s lives have an important role in the development, the maintenance and also the amelioration of children’s symptoms. Methods for encouraging parents to support graded exposure without either overwhelming the child or colluding with avoidance will be discussed.

Following traumatic incidents, there is often pressure on Mental Health Practitioners to ‘do something’. The mixed evidence concerning debriefing will be considered, and although debriefing per se is not recommended, alternative crisis interventions based on the cognitive model of reactions to trauma will be discussed.

Learning Objectives

By the end of this workshop, the participants should have a good knowledge of:

  • How children and families react to trauma
  • How a cognitive model (Ehlers & Clark 2000) can explain these reactions
  • How developmental and systemic factors impact on such a model
  • How to intervene effectively using CBT taking into account developmental and systemic issues
  • How to deal with ethical dilemmas of exposure-based treatments
  • Crisis interventions based on a cognitive model

David Trickey is a Chartered Clinical Psychologist who has worked with the Child and Family Team at the NHS Traumatic Stress since January 2000. The clinic is a national referral centre for post-traumatic stress disorder and the Child and Family team is one of only two such teams in England. His NHS post and private work involve a number of different aspects of work specialising in traumatised and traumatically bereaved children and families. These include assessment of and intervention with complex or chronic cases of trauma, consultation to other agencies, Expert Witness reports for Court and research. He is often consulted at an early stage following trauma and asked to inform the crisis response. He facilitates clinical seminars and lectures on Doctorate Clinical Psychology Training Courses. He is on the editorial board of Bereavement Care Journal. He is also trained in family therapy and Eye Movement Desensitisation and Reprocessing (EMDR).

Lucy Serpell is a Chartered Clinical Psychologist working at the Traumatic Stress Clinic and St Mary’s Hospital. Her interests in trauma developed whilst working with people with eating disorders. During this time she also completed her PhD on cognitive processes in eating disorders and has published widely in the area. She has presented her work at national and international conferences and lectures on topics in clinical and research psychology to students at Undergraduate and Masters level. Lucy is particularly interested in the challenges of applying research findings to CBT with children and adolescents.

Key References

Ehlers, A., & Clark, D. M. (2000) A cognitive model of post-traumatic stress disorder. Behaviour Research & Therapy, 38, 319-345.

Cohen, J. A., Berliner, L., & March, J. S. (2000) Treatment of children and adolescents. In E. B. Foa, T. M. Keane & M. J. Friedman Effective treatments for PTSD: practice guidelines from the International Society for Traumatic Stress Studies (pp. 330-332). New York: Guilford Press.

Meiser-Stedman, R. (2002) Towards a Cognitive-Behavioral Model of PTSD in Children and Adolescents. Clinical Child & Family Psychology 5, 217-232.