LONDON 2000: WORKSHOPS Wednesday 19th July 2000
Problem-Solving Therapy: Clinical Applications
Arthur M. Nezu and Christine Maguth Nezu, MCP Hahnemann University, USA
Intermediate and Advanced Levels
Research conducted over the past 2 decades has documented problem-solving therapy (PST) to be an effective cognitive-behavioural intervention for a wide variety of psychological disorders. Problem-solving ability is best conceived as comprising a series of specific skills, rather than a unitary ability. It is theoretically rooted in a social competence approach to coping skills training. Of particular significance are the findings that (a) increases in problem-solving skills are associated with increases in self-control and self-efficacy beliefs, and (b) the positive effects of PST are maintained over time. PST has more recently been adapted to increase coping skills of persons experiencing significant emotional and psychological difficulties engendered by chronic illness (e.g. cancer, HIV, spinal cord injury), as well as significant others. The majority of this workshop will be geared towards hands-on clinical training using a scientifically supported training manual. Clinical applications will include depression, interpersonal problems, and coping with chronic illness, such as cancer.
Attendees will learn:
•To assess both the process and products of their patients’ problem-solving efforts;
•To carry out a PST protocol as both a stand-alone and complementary treatment; and
•How to adapt PST techniques to clinically match problem areas and populations.
Practitioners and advanced students with basic knowledge and skills in cognitive and behavioural approaches to treatment will lean how to enhance their practice with the integration of problem-solving techniques.
Recommended Readings: D’Zurilla, T.J., & Nezu, A.M. (in press). Problem-solving therapy (2nd ed.) ,New York: Springer. Nezu, A.M., Nezu, C.M., Friedman, S.H., Faddis, S., & Houts, P.S. (1998). Helping cancer patients cope: A problem-solving approach. Washington, DC: American Psychological Association. Nezu, C.M., Nezu, A.M., and Houts, P.S. (1993). The multiple applications of problem-solving principles in clinical practice. In K.T.Keuhlwein & H. Rosen (Eds.), Cognitive therapy in action: Evolving innovative practice. San Francisco: Jossey-Bass.
Cognitive Therapy of Personality Disorders
Arthur Freeman, Philadelphia College of Osteopathic Medicine, USA
Intermediate and Advanced
The patients whose clinical syndromes are coded on Axis II, according to DSM-IV, are often the most difficult in the therapist’s caseload. They may require more time in therapy and greater therapist energy without much progress or change. They usually enter therapy for issues other than the personality disorder, notably Axis I depression and anxiety. Progress in these clients may be slow or stopped by the Axis II problems.
You will learn:
•About the relevant theory, assessment techniques (including the newly developed Diagnostic Profiling System), and general treatment considerations;
•About the conceptualisation and treatment strategies for each of the three clusters of personality disorders described by DSM-IV;
•About issues of noncompliance or impediments to the therapeutic regimen, along with techniques for increasing compliance and collaboration; and
•About therapeutic alliance, which will be highlighted as essential for the treatment of this patient group.
Modification of the basic cognitive therapy format will be discussed and illustrated through the use of clinical vignettes and videotape. The therapeutic goals of schematic reconstruction, schematic modification, schematic reinterpretation, and schematic camouflage will be discussed.
Recommended Readings: Beck, A.T., Freeman, A., & Associates (1990). Cognitive therapy of personality disorders. New York: Guildford Press. Layden, M.A., Newman, C.F., Freeman, A., & Byers-Morse, S. (1993) Cognitive therapy for borderline personality disorder: Needham, MA:Allyn and Bacon. (1995)
Cognitive Therapy of Social Phobia
Adrian Wells, University of Manchester
Social phobia is a common and disabling condition in which negative cognitions are often resistant to treatment. However, recent advances in theory have contributed to the way in which social phobia is conceptualised and treated. In this workshop the cognitive model of social phobia developed by Clark and Wells (1995) and the treatment based on this approach will be described. This approach emphasises the role of maladaptive self-processing and use of unhelpful coping behaviours in the maintenance of the problem. The workshop will focus on how to develop an individual case formulation, provide a structure for sequencing of treatment, and present a detailed account of strategies for producing cognitive-behavioural change.
The workshop will be suitable for practitioners at all levels.
Conduct Disorders in Children: Development, Assessment, and Effective Interventions
Robert J. McMahon, University of Washington, Seattle, Washington, USA
This workshop will provide an overview of the state-of-the-art in the development, assessment, and intervention with children presenting with conduct disorders. An in-depth review of current knowledge on the etiology of conduct disorders will be presented, with an emphasis on various developmental pathways. This perspective will form the basis of specific recommendations for "best practices" with respect to assessment and effective interventions. Current assessment methods will be described. The bulk of the workshop will focus on two approaches to intervention with these children. The first is a family-based intervention that focuses on child noncompliance in preschool and early-school age children (Forehand & McMahon, 1981; McMahon & Forehand, in preparation). The second approach is a multicomponent long-term intervention that is designed to prevent serious conduct disorders in school-age children who are at very high risk. The Fast Track project (Conduct Problems Prevention Research Group, 1992, 1999a, 1999b) includes targeted interventions such as parent training, home visiting, child social skills training, child friendship enhancement, and academic tutoring, as well as a universal classroom intervention directed to the promotion of social and emotional competence. The intervention begins in first grade and continues through Grade 10.
Assessment and Treatment of Phobic and Anxiety Disorders in Children and Adolescents
Thomas H. Ollendick, Virginia Polytechnic Institute and State University
Intermediate and Advanced
This workshop will review recent developments in the assessment and treatment of phobic and anxiety disorders in children and adolescents. Specific Phobia (SP), Separation Anxiety Disorder (SAD), Panic Disorder (PD), and Generalized Anxiety Disorder (GAD) will be highlighted. An emphasis will be placed on Empirically Supported Treatments (ESTs) and psychometrically sound and clinically useful assessment strategies. As such, single case design applications and randomised clinical control trials will be emphasised.
The workshop will provide training in the administration, scoring, and interpretation of recently developed assessment tools such as the Multidimensional Anxiety Scale for Children, the Children’s Anxiety Scale, and the Screen for Child Anxiety Related Emotional Disorders. Relations between these measures and older ones, such as the Revised Children’s Manifest Anxiety Scale and the Fear Survey Schedule for Children-revised, will be examined. The workshop will also provide training in case formulation and the selection of treatments based on assessment information. Hence, a prescriptive approach (assessment x treatment) will be espoused. In addition, cognitive-behavioural treatments that have demonstrated efficacy will be reviewed. Such treatments include relaxation training, in vivo exposure, interoceptive exposure, cognitive restructuring, operant reinforcement, and family anxiety management. Finally, issues of exporting treatments from the research laboratory to the clinic setting will be explored. Thus, the efficacy and effectiveness of these treatments will be examined.
Participants are encouraged to bring case material with them for discussion. Format of the workshop will include lecture, demonstration, role-play, and discussion. Handouts will be provided. Intermediate level of knowledge expected.
Advances in Behavioural Family Intervention
Matthew R Sanders, Parenting and Family Support Centre, The University of Queensland, Brisbane, Australia
This workshop presents an overview of a comprehensive multi-level system of parenting and family support known as the Triple P-Positive Parenting Program. Triple P was designed as a prevention oriented early intervention program for children at risk of developing severe conduct problems. The behavioural family intervention program has 5 levels of intervention which target key family risk and protective factors within a tiered continuum of increasing intensity of intervention. The program uses a broad multidisciplinary population framework, ranging from media based strategies (level 1) to intensive family intervention where parenting problems are complicated by marital conflict, parental depression and high levels of parenting stress. The workshop will provide an overview of the scientific and conceptual basis of the program, as well as key practical implementation issues. The workshop will be interactive and involve a mixture of brief didactic presentation, video demonstrations, clinical problem solving exercises and discussion. A comprehensive handout will be provided.
Cognitive Behaviour Therapy for Bulimia Nervosa and Anorexia Nervosa
Christopher G. Fairburn and Roz Shafran, Department of Psychiatry, University of Oxford
Results from over 20 randomised-controlled trials demonstrate that manual-based cognitive-behavioural therapy is the treatment of choice for bulimia nervosa. Approximately half of patients with bulimia nervosa who receive this treatment achieve a full and lasting recovery. In contrast, there are no published randomised controlled trials that demonstrate the effectiveness of CBT for anorexia nervosa.
This workshop is primarily aimed at clinicians who are familiar with the principles of CBT and wish to learn more about the specific application of these principles to patients with bulimia nervosa. The workshop will use a combination of didactic teaching, video-tapes, group exercises and role-plays to illustrate the implementation of CBT for this disorder. The workshop will end with a discussion of whether the cognitive-behavioural techniques that have been used to treat bulimia nervosa can be usefully adapted for the treatment of anorexia nervosa.
Recommended Reading: Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993). Cognitive-behavioural therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In Fairburn, C. G. (Ed); Wilson, G. T. (Ed). Binge eating: Nature, assessment, and treatment. (pp. 361-404). New York, NY, USA: The Guilford Press; Garner, D. M., Vitousek, K. M., & Pike, K. M. (1997). Cognitive-behavioural therapy for anorexia nervosa. In Garner, D. M. (Ed); Garfinkel, P. (Ed). Handbook of treatment for eating disorders (2nd ed.). New York, NY, USA: The Guilford Press; Wilson, G. T. & Fairburn, C. G. (1998) Treatments for eating disorders. In Nathan, P. E. (Ed) & Gorman, J. M. (Ed). A guide to treatments that work. New York, NY, USA: Oxford University Press.
Integrating DBT-Based Techniques And Concepts To Facilitate Exposure-Based Treatment For PTSD
Claudia Zayfert, Dartmouth Medical School and Carolyn B. Becker, Trinity University, USA
Despite the demonstrated efficacy of exposure-based treatment for PTSD, its utilisation in clinical practice remains limited. High rates of attrition, dissociation, destructive impulsivity, suicidality, and chaotic life problems are all reasons cited by clinicians for abandoning empirically supported exposure treatment. Dialectical behaviour therapy (DBT) was designed by Linehan to address many of these issues in borderline personality disorder (BPD). However, such behaviours exist on a continuum and frequently present in PTSD patients not meeting full criteria for BPD. As such, DBT has much to offer in the treatment of PTSD patients who are not considered ideal candidates for exposure therapy. This clinical workshop will present a model for integrating DBT-based techniques and concepts to improve patients’ tolerance of exposure-based CBT for PTSD.
Attendees will learn:
•When and how to integrate DBT
•How to utilise DBT concepts such as biosocial theory, dialectics and apparent competence and validation to facilitate exposure;
•How to integrate DBT skills training
This program is designed for intermediate/advanced level clinicians who have experience with exposure-based CBT for PTSD, or who have attended workshops such as those conducted by E. Foa & C. Dancu on exposure treatment for PTSD. Familiarity with DBT is also recommended.
Recommended Readings: Linehan, M.M. (1993). Cognitive-behavioural treatment of borderline personality disorder. New York: Guilford Press. Linehan, M.M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press. Foa, E. B. & Rothbaum, B.O. (1998). Treating the trauma of rape: Cognitive-behavioural therapy for PTSD. New York: Guilford Press.
Cognitive Behavioural Therapy in Manic Depression
Dominic Lam and Jeny Bright, Institute of Psychiatry, London
Bipolar affective disorder is a serious illness with significant suicide risk and high social cost. Treatment for manic depression in the past three decades has been predominantly pharmacotherapy. Lithium carbonate has been the most common and influential drug of choice. Yet more recently questions have been raised about the effectiveness of Lithium in normal clinical settings (Solomon et al, 1995; Moncrieff 1995). Lithium is ineffective for at least 20% to 40% of classical bipolar patients, either due to inadequate responses or side effects (Prien & Potter 1990). Other common prophylactic drugs such as Carbamazepine and Valproate generally only show equivalent efficacy to Lithium (Salomon et al. 1995).
Due to the above findings, the 1989 National Institute of mental Health Workshop on Treatment of Bipolar Disorder (Prtien and Potter, 1990) urged that more research should be directed both to alternative drug strategies and to the development of psychotherapies specific to this disorder. We have conducted a randomised controlled pilot study with encouraging results (Lam, Bright, Hayward et al. in press). Currently we are recruiting 100 bipolar patients for a Randomised Controlled Trial to replicate our finding of the pilot study.
This workshop is based on the book by the same title (Lam, Jones, Hayward and Bright 1999). It targets qualified mental health professionals with a cognitive behavioural background who are interested to work with bipolar patients. The aim of the workshop is to equip participants with the necessary knowledge and techniques to conduct CBT with bipolar patients. The aims of the workshop are:
• to be familiar with the diagnosis and classify bipolar illness into subtypes;
• to be able to list the outcome and course of illness and the effectiveness of prophylactic medication;
• to be able to define and elicit common prodromes;
• to list and describe the vulnerability issues;
• to be able to describe the common CBT techniques for bipolar illness.
Didactic teaching, discussion, video tapes of therapy and roleplays will be used.
Lam, D.H., Bright, J., Jones, S., Hayward, P., Schuck, N., Chisholm, D., & Sham, P. (In press). Cognitive therapy for bipolar illness - a pilot study of relapse prevention. Cognitive Therapy and research
Lam, D.H., Jones, S.H., Haywood, P. & Bright J.A. (1999) Cognitive Therapy for Bipolar Disorder: A Therapist’s guide to concepts, methods and practices. Wiley & Son, London
Lam, D.H. & Wong, G. (1997) Prodromes, coping strategies, insight and social functioning in bipolar affective disorders. Psychological Medicine, 27, 1091-1100
Cognitive-Behavioural Treatment for Dual Diagnosis Individuals with Psychotic and Substance Misuse Problems
Gillian Haddock, Christine Barrowclough and Jan Moring, University of Manchester
Little research has been carried out evaluating cognitive-behavioural treatment of schizophrenia and co-existing substance use problems. However, a recent trial carried out at the University of Manchester has shown that an integrated family and individual CBT programme can produce significant clinical benefits for psychotic symptoms and substance use problems. This workshop will focus on how family and individual CBT approaches can be modified to treat people who have co-existing schizophrenia and substance use problems. The workshop will highlight how the two approaches should be integrated to allow the needs of both patient and families to be addressed. In addition, the workshop will demonstrate how motivational interviewing can be integrated with CBT to address substance use problems. The workshop will be illustrated using case examples and participants will be given the opportunity to discuss their own case material.
Assessment And Treatment Of Anger And Aggression In People With Learning Disabilities
John Taylor, Northgate Hospital, Northumberland
Population surveys of people with learning disabilities have shown aggressive behaviour to be a particular concern with this client group. The relationship between anger and aggression has been well articulated by Novaco (1994) who asserted that anger is a subjective emotional state involving physiological arousal and cognitions of hostility, and is a causal determinant of aggression. Further, Novaco (ibid.) has demonstrated that anger control problems are highly predictive of physical aggression in psychiatric hospital in-patients.
Significant levels of anger control problems have been found in people with learning disabilities accessing mental health services (see for example Benson, 1985). Research on anger treatment for people with learning disabilities is limited. However, there are 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 learning disabilities (Stenfert Kroese et al., 1997).
This workshop is based on work that has been carried out recently at Northgate Hospital in Northumberland with learning disabled offenders. A detained in-patient group of 127 learning disabled men were assessed on a range of anger and aggression measures in order to investigate the nature and scope of anger problems in this population. Based on these assessments a sample of this population with clinically severe anger problems has taken part in a controlled trial of a cognitive-behavioural anger treatment based on a modified version of 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 works through content, process and evaluation issues in applying a cognitive-behavioural approach with reference to a newly developed anger treatment protocol.
• To familiarise workshop participants with the literature relating to anger and aggression problems in people with learning disabilities and the evidence for the effectiveness of anger treatment.
•To provide an opportunity for participants to consider assessment issues when working with anger and aggression problems with this population.
•To help participants understand how a systematic and planned cognitive-behavioural treatment for anger problems can be effective and has benefits for individual clients, carers/supporters and organisations working with this group.
You will learn:
The workshop will help participants have a better understanding of the following:
•The prevalence of anger and aggression in populations of people with learning disabilities.
The interrelationship of anger and aggression and the evidence for the effectiveness of cognitive-behavioural anger treatment approaches.
•The importance of robust assessment of anger problems in developing good formulations and treatment plans for individual clients.
• The value of delivering a well evaluated anger treatment protocol to alleviate the problems associated with poor anger control in clients with learning disabilities.
Recommended Reading: Benson, B.A. (1985). Behaviour disorders and mental retardation: Associations with age, sex and level of functioning in an outpatient clinic sample. Applied Research in Mental Retardation, 6, 79-85; Harris, P. (1993). The nature and extent of aggressive behaviour amongst people with learning difficulties (mental handicap) in a single health district. Journal of Intellectual Disability Research, 37, 221-242; Novaco, R.W. (1994). Anger as a risk factor for violence among the mentally disordered. In J. Monahan & H.J. Steadman (Eds), Violence and Disorder: Developments in Risk Assessment, pp 21-59. Chicago: University of Chicago Press.; Smith, S., Branford, D., Collacott, R.A., Cooper, S.A., & McGrother, C. (1996). Prevelance and cluster typology of maladaptive behaviours in a geographically defined population of adults with learning disabilities. British Journal of Psychiatry, 169, 219-227; Stenfert Kroese, B., Dagnan, D., & Loumidis, K. (1997). Cognitive – behavioural therapy for people with learning disabilities. London: Routledge.
Training and Supervision in CBT
Melanie Fennell, Warneford Hospital, Oxford
Research suggests that, to ensure clinical effectiveness, adherence to the cognitive therapy protocol is essential. This requires therapists to possess not only sound theoretical knowledge of cognitive models of emotional disorder, but also a broad, flexible and well-practiced repertoire of cognitive-behavioural procedures. Even for experienced therapists, training others in these complex performance skills is no easy task. Yet the high volume of potential patients requires that knowledge and skill should be widely and effectively disseminated.
The workshop draws on its leader's experience as Director of the Oxford Diploma in Cognitive Therapy. It uses ideas from management development and from education as a basis for considering what the content of cognitive therapy training should be, and how trainers may develop an active learning environment which mirrors the collaborative style of cognitive therapy. By the end of the workshop, participants will: a) understand the content of cognitive therapy training in terms of a 3-dimensional model of meetings derived from management development training; b) have identified how the theory and practice of cognitive therapy inform training and supervision, creating a learning culture that reflects the qualities of the therapy itself; c) understand how use of Kolb's learning circle encourages learning and retention; d) Have designed a forthcoming training event, using ideas and methods from the workshop.
The workshop is intended for experienced cognitive therapists now supervising and training others in cognitive therapy. Participants will be expected to relate what they learn to their own experience as trainers, and to participate actively in practical exercises.
The Use of Structured CBT Self-Help Materials to Treat Depression within non-specialist Settings
Chris Williams, Frances Cole and Stephen Williams,University of Leeds
Level: Introductory/Intermediate practitioners: especially suitable for those practitioners new to CBT, or those wanting to consider using an accessible form of CBT within non-specialised settings.
We will present a Five Areas model of Assessment that has been developed for use within Primary Care settings. The day will cover:
A brief introduction to the CBT approach.
An overview of the use of CBT self-help materials.
A description of the Overcoming Depression Course that is available for use within training and teaching.
You will be able to describe how to carry out a Five Areas Assessment of mood/using a Thought Diary and practice this approach using role play.
You will be able to describe the Vicious circle of reduced activity and learn how to assess the impact of unhelpfully altered behaviour on mood.
You will be able to practice changing extreme and unhelpful thinking by using structured self-help materials and use a Thought Worksheet.
You will be able to describe the components of Practical Problem solving, and be able to practice using the principles of effective problems solving in practice.
You will hear about the development of a training course to train practitioners in the use of the Overcoming Depression Course within one Health Authority.
Andrews G. Talk that works: the rise of cognitive behaviour therapy. British Medical Journal 1996; 313: 1501-2.
Craig, T K J, Boardman, A.P. Common mental health problems in primary care. British Medical Journal, 314, 1609-1612.
Department of Health. National Service Framework for Mental Health: Modern Standards and Service models. London: Department of Health, 1999.
Gould, R.A. & Clum, A.A Meta-analysis of self-help treatment approaches. Clinical Psychology Review 13, 169-186 (1993)
Working with Traumatic Memory Using Imagery Techniques in Cognitive Therapy.
Ann Hackmann, University of Oxford
A workshop for those with a background in cognitive therapy interested in learning more about traumatic memory, and the usefulness of imagery techniques for accessing and transforming meanings of distressing memories in PTSD and various other disorders.
•Learn about a cognitive model of PTSD (Ehlers and Clark), together with up to date information about traumatic memory.
• Understand from this why imagery techniques may be particularly useful with traumatic memories, either from adult life or from childhood, in PTSD and other disorders.
• Learn how to access traumatic memories and their meanings.
•Learn how to transform the meanings of memories using imagery techniques with a cognitive rationale.
•Observe how using such techniques affects cognitions, affect and behaviour, in the short and the long term.
Methods used in the workshop will include:
Short didactic presentations
Observation and discussion of video material
Role play of the techniques
Discussion and experiential work with your own cases
Handouts of all overheads, and reference lists
Overcoming Shame: The REBT Perspective on Treatment
John Blackburn & Rob Willson, Community Health Sheffield NHS Trust
This workshop will introduce and develop participants understanding of the Rational Emotive Behaviour Therapy (REBT) conceptual and treatment approach to shame problems.
The workshop will be suitable for all levels of participants; from novices to advanced practitioners. It will include small group work, experiential learning, as well as the use of video and live demonstrations.
The workshop learning objectives are:
i) Understanding the role of shame in emotional and behavioural disturbance
ii) Key concepts of brief REBT
iii) Application of REBT to shame problems
Reason and Emotion in Psychotherapy, A. Ellis (1994) Birch Lane Press
Brief Rational Emotive Therapy, W. Dryden (1995) Wiley
Overcoming Shame, W. Dryden (1996) Sheldon Press
Integrating Physical and Psychological Models when Working with People with Chronic Pain
Clare Daniel, Kathryn Nicholson Perry, Jan van der Meere, St Thomas Hospital, London
The aims of this workshop are to:
• To gain an integrated theoretical understanding of chronic pain.
• To develop an appreciation of the impact of chronic pain on the individual and their significant others
• To gain an understanding of the assessment and treatment of chronic pain within a cognitive behavioural framework
Chronic pain is a prevalent condition with enormous individual and socio-economic costs. There are many misconceptions about the causes and nature of this condition which need to be addressed and understood if accurate and useful assessments, formulations and interventions are to be achieved.
This interactive workshop will support participants in formulating and understanding the issues which arise as a result of having chronic pain through the use of role plays,videos, vignettes and discussion. The workshop will initially provide a basic theoretical understanding of pain with a particular focus on thee Gate Control Theory, its use in understanding the often unusual symptomatologies of pain and its role in helping professionals to comprehend the integration of physical and psychological variables in relation to pain. This will principally focus in the ways in which chronic pain violates peoples’ long held assumptions (largely based on their previous experience) regarding pain, damage and medical treatment.
The workshop will then address the factors which maintain and exacerbate the distress and disability which result from chronic pain and which reinforce the unhelpful cycles in which people find themselves.. The focus will be on i) cognitive factors, ii) emotional states such as fear, anger and depression and iii) behavioural factors including the role of avoidance, reinforcement by others and the use of medication..
The latter part of the workshop will focus on the assessment of people with chronic pain including i) physical and psychological factors, ii) the formulation in relation to the individual and the impact of their pain and iii) the aims and components of treatment. Some of the professional dilemmas posed by this area of work will also be addressed
Empirically Validated Treatments for OCD and Panic Disorder
Maureen L. Whittal, Vancouver Hospital, University of British Columbia ,Canada
Recent theoretical advances in the cognitive behavioural treatment (CBT) of OCD appear promising and may improve the outcomes of well-established exposure-based treatments, which can be difficult to tolerate. Moreover, CBT may be particularly useful in treating people with primary obsessions, who have traditionally achieved less success with exposure and response prevention approaches. Because of the heterogenous presentation, cognitive-behavioural treatment of OCD depends on an idiosyncratic assessment and formulation. The standard assessment tool, the Yale-Brown Obsessive-Compulsive Scale, will be reviewed as will other cognitive assessment measures. The cognitive-behavioural model will be introduced and the cognitive processes thought to be important will be discussed. The traditional exposure plus response prevention treatment will also be discussed with a view to integrating it with cognitive approaches.
CBT of panic disorder, with and without agoraphobia has been firmly established as the psychosocial treatment of choice. It also appears to be effective for patients who wish to discontinue benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) in the context of CBT. Depending upon the level of familiarity amongst the attendees, the components of panic treatment will be presented and discussed. A protocol for permitting patients to discontinue their medications will be presented. Please bring case histories and problematic OCD and panic patients for discussion.
You will learn:
•The cognitive model of obsessive-compulsive disorder and panic disorder and its implications for treatment
• The importance of assessment and case formulation for successful treatment
• The cognitive processes thought to be relevant in OCD
• How to successfully challenge a patient’s cognitive interpretations without trying to talk them out of their obsessions
• Tools to help patients control panic
• How to assist patients in coming off of their panic-blocking medications.
Recommended readings: Obsessive-compulsive cognitions working group (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667-682., Otto, M. W., Pollack M. H., Sachs, G. S., Reiter, S. R., Meltzer-Brody, S., & Rosenbaum, J. F. (1993). Discontinuation of benzodiazepine treatment: Efficacy of cognitive-behaviour therapy for patients with panic disorder. American Journal of Psychiatry, 150, 1485-1490., Otto, M.W., & Whittal, M.L. (1995). Cognitive-behaviour therapy and the longitudinal course of panic disorder. The Psychiatric Clinics of North America, 18, 803-820., Salkovskis, P. M. (1999). Understanding and treating obsessive compulsive disorder. Behaviour Research and Therapy, 37, S29-S54., Whittal, M.L., & McLean, P.D. (in press). CBT for OCD: The rationale, protocol, and challenges. Cognitive and Behavioural Practice.