IN-Conference Workshops.
Thursday 9th - Saturday 11th September

Delegates attending the EABCT Congress will be able to attend one or more of the half-day workshops (2-3 hours) that have been scheduled in the programme. There is a small extra charge of £20 for each of these workshops. You can make a booking in advance by using the booking form below. Alternatively you can register when you arrive at the Congress. Places will be limited for each workshop and will be allocated on a first come first served basis.

Thursday 9th

9.00 - 11.30
T1

Mindfulness-based cognitive therapy. A workshop for instructors.
Mark Williams, Oxford, UK and
Antonia Sumbundu, Denmark


T2

Cognitive behavioural treatment for chronic illness focusing on diabetes
Trudie Chalder and Suzanne Roche, London,UK

T3

The Treatment of Terrorist Related Trauma in Children and Adolescents
Alistair Black, Child and Adolescent Therapy Service, N. Ireland


T4

Assessment of Cognitive Therapy Skills for People with Intellectual Disability and Lower Ability
Dave Dagnan, Northumbria, UK

T5
Cognitive Behavioural Treatment of Unwanted Mental Intrusions in Anxiety and Depression
David A. Clark, Canada

 

Thursday 9th

13.30 - 16.00
T6

Lies, Damned Lies And Information Processing: Making sense of false memory, flashbacks and other tricks of the mind
Helen Kennerley, Oxford, UK

T7

Clinical Methods for the Early Identification and Treatment of Pain
Steven Linton, Orebro University, Sweden

T8

Couple Therapy: Helping couples who suffer from relationship and/or sexual problems
Mehmet Sungur, Istanbul, Turkey
Kevan Wylie, Sheffield, UK


T9
Staying well after psychosis: a cognitive behavioural approach to relapse prevention
Andrew Gumley, Glasgow, Scotland

T10
Applying verbal and non-verbal techniques in skills directed therapy with children and adolescents
Tammie Ronen, Tel Aviv, Israel

 

Friday 10th

9.00 - 11.30
F1

Delivering CBT self-help to a community: providing multiple access points to treatment
Chris Williams, Glasgow &
Ruth Lang, Depression Alliance Scotland


F2

Cognitive behavioural body image therapy for anorexia and bulimia nervosa
Silja Vocks & Tanja Legenbauer, Germany

F3

Trialing Cognitive Behaviour Therapy for children with OCD: A randomised controlled trial
Tim Williams, Berkshire, UK

F4

Identity Issues in PTSD
Chris Brewin, London, UK

Cancelled
CBT for Psychosis in routine care - interventions to aid recovery
Katy Grazebrook, Manchester, UK

F6
Establishing Healthy Affect Control in Clients diagnosed with Personality Disorders or Complex Trauma through the Repair of Early Attachment Problems
Claudia Herbert, Oxford, UK

F7

Developing clinical skills in the neglected art and science of CBT for Panic and Agoraphobia.
John Manley, London, UK.

 

 

Friday 10th

13.30 - 16.00
F8

Psychotherapy for heterosexual couples, for gay couples and for lesbian couples: why three different therapies?
Antonella Montano, Rome, Italy and Memet Sungur, Istanbul, Turkey

F9

Supervision of professionals working with children and young people – issues dilemmas and good practice
Anne Stewart, Oxford, UK

F10

Cognitive Therapy for chronic insomnia
Alison Harvey, Oxford, UK

F11

Assessing, Predicting, and Overcoming Treatment Roadblocks with Complex PTSD: Developing CBT Interventions in Accordance with Specific Trauma Characteristics
Merv Smucker, Wisconsin, UK and
Anne Boos, Dresden, Germany

F12
Cognitive-behavioural therapy for generalized anxiety disorder: Learning to tolerate uncertainty and emotional arousal
M. J. Dugas, Montreal, Canada

F13
Disseminating CBT skills across the workforce: a training programme in equipping non-specialist clinicians in delivering protocol based CBT interventions.
Chris Williams, Glasgow, Scotland and
Anne Garland, Nottingham, UK

 

Saturday 11th

9.00 - 11.30
S1

‘ Stress Control’ large group didactic therapy for emotional disorders
Jim White, Glasgow, Scotland

S2

Making CBT Meaningful for People with Intellectual Disabilities: From Theory to Practice
Andrew Jahoda, Scotland and
Dave Dagnan, Northumbria, UK


S3

Cognitive Behaviour Therapy for Bipolar Disorder
Steven Jones and John McGovern, Manchester, UK

S4

Motivational Interviewing: Revisiting the Basics
Henck Van Bilsen, Royston, UK

S5
Cognitive Behaviour Therapy for Body Dysmorphic Disorder
David Veale, London, UK and
Fugen Neziroglu, USA


 

Saturday 11th

13.30 - 16.00
S6

Exposure to the imaginative death experience in hypochondrias
Jan Prasko, Prague, Czech Republic

S7

CBT for anxiety/depression in patients with the diagnoses Asperger and AD/HD
Elizabeth Ekman, Gothenburg, Sweden

S8

Cognitive Therapy for post traumatic stress disorder in the context of civil conflict using the Elhers Clark model of PTSD
Kate Gillespie and Michael Duffy, Omagh, Northern Ireland

S9
Collaborative Interviewing in Mathematical Analogy Technique (CLIMATE): socialising the patient into CT using a step-by-step analysis and synthesis technique
L Konstandinidis & Gregoris Simos, Thessaloniki, Greece

 

 

Workshop T1

Mindfulness-based Cognitive Therapy - A workshop for instructors

Mark Williams, University Department of Psychiatry, Warneford Hospital Oxford and Antonia Sumbundu, Cent er for Cognitive Therapy, St. Hans Hospital, Roskilde

Background. Mindfulness-based cognitive therapy (MBCT) combines Jon Kabat Zinn's Stress Reduction program with techniques from Cognitive Therapy in an eight week 'class' format. Following preliminary evidence for its efficacy in reducing relapse and recurrence in patients who have had three or more episodes of depression, interest has grown in applying the mindfulness approach to a variety of mental health problems across a range of different settings.

Who the workshop is aimed at: This workshop is for health professionals who have experience in applying the mindfulness approach in their clinical work.

The learning objectives: By the end of the workshop, participants will have had the opportunity to hear other instructors' experience of teaching mindfulness classes; to dialogue with others about how to deal with issues that arise from running the classes; to see how best to respond when difficulties arise.

The teaching methods: Dialogue, mindfulness practice

Short description of workshop leaders:Mark Williams is Wellcome Principal Research Fellow in the University of Oxford. He has been interested in cognitive models and treatment of depression and suicidal behaviour for many years, and has recently been collaborating with John Teasdale and Zindel Segal in developing this mindfulness-based cognitive therapy to prevent relapse and recurrence in major depression.

Antonia Sumbundu is clinical psychologist at the Centre for Cognitive Therapy at St. Hans Hospital, where she teaches at and co-ordinates a training program in CBT, supervises staff in CBT, offers CBT and runs mindfulness-based groups for patients. She has been interested in cognitive therapy, mindfulness meditation and Buddhist psychology for many years and teaches and supervises mindfulness based approaches in a number of settings.

Relevant background readings:
Kabat-Zinn, J.(1990) Full catastrophe living. New York: Delacorte.

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

Baer, R.A. (2003) Mindfulness training as clinical intervention: a conceptual and empirical review. Clinical Psychology Science and Practice, 10, 125-143 (and subsequent papers in that edition of the journal)

Workshop T2

Cognitive behavioural treatment for chronic illness focusing on diabetes

Chalder T , Department of Psychological Medicine, Guy’s, King’s & St Thomas School of Medicine & Roche S, Chronic Fatigue Syndrome Research and Treatment Unit, South London and Maudsley NHS Trust.

A variety of cognitive behavioural interventions have been used to improve chronic disease outcomes. In diabetes, the interventions that have been tried, include multi-family group therapy, problem solving, self-management training in families where patient and parents are seen in separate groups, family therapy, patient empowerment, problem solving in individuals, cognitive analytic therapy, relaxation therapy, and stress management. Although there is little evidence that these psychological interventions are effective in improving glycaemic control the upper limit of the confidence interval suggests that they could potentially be very effective. There are a number of problems with the studies methodologically and it is possible that the interventions have been too general and have not focused on the illness specific cognitions and behaviours which may result in poor health outcomes. An evidence based psychological model such as Beck’s model of emotion may result in the interventions being more focused and appropriate.

Using case examples, we will present such a model. By modifying illness specific beliefs and behaviours, we aim to improve the patients understanding and overall care of their diabetes, thereby influencing glycaemic control. We will discuss specific interventions, appropriate rationales and some of the common problems we encounter when treating this client group.

Learning Objectives: Participants will have a theoretical understanding of how to conceptualize difficulties reported by patients with diabetes

Participants will have a range of cognitive behavioural techniques at their disposal which may be used to help patients improve their self efficacy.

Training modalities: experiential (role-play and didactic teaching)

Key references:
Coping with fear of long term complication in Diabetes mellitus: A model Clinical Program. (1995) Zetter A Eral. Psychotherapeutics & Psychosomatics; 64:178-184.

Cognitive Behaviour Therapy for Depression in Type 2 Diabetes Mellitus: A randomised. controlled trial (1998) Lustmen J P, et al, 129:613-621 Annals Internal Medicine.

CBT for Chronic Medicine Problems: A guide to assessment and treatment in practice. Craig A White. published by: Wiley.

Workshop leaders:
Trudie Chalder is Professor of Cognitive Behavioural Psychotherapy at Guy’s, King’s & St Thomas’ School of Medicine, London. Her clinical and research interests include developing models and treatments for medically unexplained symptoms and chronic diseases. She is involved in a RCT in which diabetes specific CBT is being evaluated within the context of a RCT.

Suzanne Roche is a cognitive behavioural psychotherapist at the South London and Maudsley NHS Trust. She is treating patients with diabetes within the context of a HTA funded RCT. She has helped to develop the treatment used in the trial.

Workshop T3

The Treatment of Child and Adolescent Terrorist Related Trauma

Black A.R.J. Police Rehabilitation and Retraining Trust - Child and Adolescent Therapy Service, Northern Ireland

The workshop will examine terrorist trauma and its impact on children and adolescents and how this traumatic event differs from other stressors. Terrorist trauma will be initially defined and explored in terms of traumatic acts perpetrated by organised extremists or individuals. Therefore this workshop will be particularly relevant in the treatment of those who have experienced such acts first hand or vicariously. As terrorism is a global issue this workshop will be relevant to many populations internationally including those working with the children of refugee groups.

Various types of critical incident will be examined along with associated PTSD symptoms. In addition the concept of secondary trauma will be explored and the impact of parental psychopathology on children and the family unit. The workshop will also cover factors that complicate treatment and affect prognosis such as multiple terrorist incidents, ongoing terrorist threat and the lack of ability due to age in conceptualising terrorist attacks.

In addition to exploring psychopathology traditionally associated with trauma other trauma related childhood symptoms will be examined such as OCD, self-harm, eating disorders etc. and how this is incorporated into the treatment plan. The main treatment approach presented will be cognitive behavioural psychotherapy but other therapeutic tools such as EMDR, art and play therapy will be explored in the context of the CBT model.

Learning Objectives:
Participants will:

-Gain an overview of terrorist related trauma and how this differs from other traumatic stressors.

-Examine how terrorist related trauma impacts on children and young people's mental health, level of functioning and perception of the world.

-Explore PTSD symptoms including vicarious traumatisation due to parental psychopathology

-Gain an understanding of how trauma in children and adolescents may be displayed in other symptoms such as OCD, eating disorders and deliberate self harm

-Be able to formulate a treatment plan for children and adolescents affected by terrorist related trauma including being able to prioritise treatment targets and deal with additional complications such as an ongoing terrorist threat and multiple terrorist acts.

The workshop will involve a didactic element including the presentation of clinical case studies illustrating terrorist related trauma within this population and also an experiential element incorporating group exercises and discussion focusing on formulating a CBT treatment plan for children and young people who have suffered trauma due to acts of terrorism.

Workshop Leader:This workshop will be led by Alastair Black who runs the Child and Adolescent Therapy Service for the Police Rehabilitation and Retraining Trust in Northern Ireland. This CBT service provides treatment for children and young people who have developed mental health problems due to experiencing terrorist attacks, an ongoing terrorist threat or as a result of their parent's police service and related psychopathology. Alastair also provides CBT clinics within child psychiatry and adolescent psychiatry within Northern Ireland. He is a BABCP accredited Cognitive Behavioural Psychotherapist and an EMDR Europe Approved Consultant and is currently conducting research into the psychological health of police children in Northern Ireland.

Workshop T4

Assessment of Cognitive Therapy Skills for People with Intellectual Disability and Lower Ability

D.J. Dagnan, University of Northumbria in Newcastle

This workshop will examine the assessment of core cognitive-emotional skills that suggest that people will be able to work effectively within a cognitive therapy framework. The Workshop will take its starting point the core process for identifying cognition within a therapeutic interaction. Thus when working with clients we start with the emotion, identify the associated activating event subsequently identifying mediating cognition. The assessment process will be discussed following this structure. We will discuss emotion recognition skills, emotional language skills and skills in rating emotion and other self-report skills. We then will describe assessments of the ability of individuals to link emotions and activating events and finally discuss the assessment of ability to identify cognitive mediation and to adjust cognitive self-talk in response to variation in emotion and event. This assessment structure allows identification of the forms of cognitive therapy (verbal self regulation, verbal self control and cognitive behaviour therapy) associated with the various skills identified within the assessment framework.

Learning Objectives: Participants will identify assessments of emotion recognition skills, assessment of emotional language, assessments of the ability to link activating events and emotions, and assessments of skills involved in cognitive mediation.

Participants will identify links between the forms of therapy suitable for people with lower ability and the skills identified within the assessment framework

Suggested References:
Dagnan, D., Chadwick, P., & Proudlove, J. (2000) Towards and assessment of suitability of people with mental retardation for cognitive therapy. Cognitive Therapy and Research, 24, 627-636.

Dagnan, D., & Chadwick, P. (1997) Components of cognitive therapy with people with learning disabilities. In Kroese, B., Dagnan, D., & Loumidis, K. (Eds) Cognitive Therapy for People with Learning Disabilities. London: Routledge..

Safran et al (1993) Assessing patient suitability for short-term cognitive therapy with an interpersonal focus. Cognitive Therapy and Research, 17, 23-28

Workshop Leader: Dave Dagnan has published a number of studies around cognitive therapy with people with and without learning disabilities. He has been working clinically and teaching other professionals in the area of cognitive therapy for nearly ten years. He currently works as a Consultant Clinical Psychologist and Clinical Director at the Learning Disability Services in North Cumbria.

Workshop T5

Cognitive Behavioural Treatment of Unwanted Mental Intrusions in Anxiety and Depression

David A. Clark, University of New Brunswick, Canada

Disturbing thoughts, images and impulses that unintentionally but repeatedly intrude into conscious awareness are a prominent clinical feature of many anxiety disorders and depression. This workshop will introduce participants to the concept of unwanted cognitive intrusions, their role and function in anxiety and depression, and how this cognitive phenomena can be distinguished from other types of negative cognition. Assessment methods and case conceptualizations that focus on the key faulty appraisals and ineffective mental control strategies associated with unwanted intrusions will be discussed. The latter half of the workshop will be devoted to the presentation and discussion of specific cognitive interventions and behavioural exercises used to modify the faulty appraisals and dysfunctional control responses that characterize unwanted mental intrusions.

Participants will learn (a) about the role of unwanted intrusive thoughts in anxiety and depression, (b) how to tailor their assessment methods and case conceptualizations to include intrusive cognitions, (c) how to identify the faulty appraisals and control strategies associated with clinical intrusive thoughts, and (d) how to implement specific cognitive and behavioural interventions to modify dysfunctional responses to unwanted intrusive cognition.

Training will be primarily didactic with extensive use of case illustration, discussion and computer-assisted presentation. In addition role play demonstrations and possibly videotaped simulated therapy segments will be used to highlight various aspects of treatment.

Key References:
Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. New York: Guilford.

Rachman, S. J. (1981). Part I. Unwanted intrusive cognitions. Advances in Behaviour Research and Therapy, 3, 89-99

Wegner, D. M., & Pennebaker, J. W. (Eds.) (1993). Handbook of mental control. Englewood Cliffs, NJ: Prentice Hall.

Workshop Leader: David A. Clark, PhD, professor in the Department of Psychology, University of New Brunswick, Canada, received his doctorate from the Institute of Psychiatry. Dr. Clark has published widely on cognitive theory and therapy of depression and OCD, and is a founding fellow of the Academy of Cognitive Therapy. He has authored and edited several books and instruments including Scientific Foundations of Cognitive Theory and Therapy of Depression with Aaron T. Beck and Brad Alford (Wiley, 1999), Cognitive-Behavioural Therapy for OCD (Guilford, 2004), the Clark-Beck Obsessive-Compulsive Inventory (Psychological Corporation, 2002), Cognitive Therapy Across the Lifespan: Evidence and Practice with Mark Reinecke (Cambridge University Press, 2003), and he is preparing an edited book on unwanted intrusive thoughts that will be published by Guilford Press. Currently Dr. Clark has a funded research program on the intentional control of unwanted intrusive thoughts which he is conducting with Dr. Christine Purdon, University of Waterloo. Dr. Clark is also a founding member of the Obsessive Compulsive Cognitions Working Group and serves as an Associate Editor of Cognitive Therapy and Research.

Workshop T6

Lies, Damned Lies And Information Processing: Making Sense Of False Memory, Flashbacks And Other Tricks Of The Mind.

Helen Kennerley, Oxford Cognitive Therapy Centre, Oxford

Abstract: Much of the work of cognitive therapists assumes an understanding of memory and information processing – particularly if we work with trauma. For example, we are often faced with the challenge of helping clients manage flashbacks or with the dilemmas of working with possible false memories. A basic knowledge of information processing facilitates this work enormously and is highly relevant to practitioners working with both type I and type II trauma. It is also essential in understanding and helping any client who suffers with symptoms of dissociation.

This is a half-day workshop for those whose appreciation of the physical and psychological basis of memory has grown rusty, and for those who missed out on it in their training. The session will comprise: an overview of how memory works; an understanding of phenomena such as false memory, flashbacks and other aspects of dissociation; guidelines for clinical work. An understanding of neuro-psychology is not assumed as the workshop aims to be accessible to all practitioners.

Learning objectives:
1. To become familiar with the basics of information processing
2. To become familiar with aspects of information processing associated with trauma
3. To consider the clinical implications of this

Training modalities:
Didactic
Small group tasks
Group discussion

Key references:
Baddeley A (1996) Your memory: a user’s guide, Prion

McNally RJ (2003) Remembering trauma, Harvard University Press

Williams JMG et al (1977) Cognitive psychology and emotional disorders, Wiley

Workshop leader: Helen Kennerley is a consultant clinical psychologist with The Oxford Cognitive Therapy Centre (OCTC) and the Oxfordshire Mental Health Trust. She trained as a cognitive therapist in Oxford and later with Jeff Young and Christine Padesky in schema-focused CBT . She is one of the founder members of OCTC.

Clinically, she has specialised in childhood trauma and maintains a particular interest in dissociative disorders, self-injurious behaviours and eating disorders and has published in these areas. She has presented many workshops both nationally and internationally and in 2002, the BABCP membership voted her one of the most influential female cognitive therapists in Britain.

Workshop T7

Clinical Methods for the Early Identification and Treatment of Pain

Steven Linton, Department of Occupational and Environmental Medicine, Örebro University Hospital & Department of Behavioural, Social, and Legal Sciences—Psychology, Örebro University, Örebro, Sweden

Learning Objectives:
To understand better risk factors and why pain develops into a persistent problem

  • To have an overview of a system for early identification and intervention
  • To understand and be able to work with psychological barriers to return-to-work
  • To learn the administration and use of a psychological screening instrument
  • To learn about leading an early CBT method for “at risk” patients

In this workshop you will learn to employ cognitive and behavioural techniques in order to identify patients likely to develop chronic pain, and to then provide suitable interventions. Psychological factors such as beliefs, fears, and pain behaviours are closely related to the development of chronic pain. Consequently, they are extremely valuable in the early identification of patients who risk developing such problems. We will work with a screening instrument that may also be used to tailor the early intervention. A CBT intervention has been expounded to address the common psychological factors associated with the development of persistent pain and disability. Moreover, this intervention has been developed to engage the patient in the treatment. Results from randomised trials suggest that it may be an effective method. We will go through the content of this intervention as well as the skills needed to lead such a group. I suggest that early identification may be achieved with CBT based screening and assessment. By addressing the psychological factors identified in a CBT group intervention, chronic pain problems may be prevented.

Professor Steven Linton is a leading researcher in the development of early interventions to prevent chronic pain. He is a co-author of the first document from the pioneering New Zealand study of psychosocial indicators that influence long-term disability and return to work. He is a widely published psychologist and researcher, has conducted several randomised controlled trials of CBT for pain problems, and he is an editor of the journal “Pain”.

Workshop T8

Couple Therapy: Helping couples who suffer from relationship and/or sexual problems.

Mehmet Sungur, Medical School of Marmara University, Istanbul, Turkey and Kevan Wylie, Sheffield UK.

Abstract: Different types of couple problems demand different therapeutic skills and responses. Whatever treatment approach is used, a good assessment and formulation is of great importance for a successful intervention, particularly in those couples presenting with relationship and sexual problems. It is generally considered inappropriate to offer sex therapy to couples with relationship problems, on the assumption that treatment is most likely to fail or remain uncompleted. However, some therapists question the validity of withholding sex therapy where relationship distress is present especially if the sexual dysfunction produces the secondary marital discord. Improvements in marital adjustment attained after therapy may be related to the emphasis placed on marital factors during sexual dysfunction treatment. In one crossover design study couples received (in a group format) either directive sex therapy followed by behavioural marital therapy or vice-versa. Sex therapy helped both sexual and marital problems whereas marital therapy helped marital problems only. Some sex therapy techniques are very helpful in marital therapy and can be used in conjunction with more traditional techniques which includes helping the couple through hostilities, poor communication, fear of emotional closeness and difficulty in verbalising desires and as a concrete demonstration of the importance of quid pro quo manoeuvres. The procedure of taking turns giving and receiving pleasure taps deep emotional reactions in both partners and can be used as an evaluative test to determine several interactional intra psychic factors.

This workshop will also cover the cognitive-behavioural systems approach to treatment of couples who have relationship and sexual problems. In this approach, the focus of therapist attention is the relationship rather than the individual and thus communication training reciprocal negotiation and mutual problem solving become very important components of treatment.

Learning objectives: The workshop aims to teach participants how to best assess and evaluate whether couples need sexual or couple or combined treatments. It also aims to teach partners how to clarify joint-practical-interactional goals and how to challenge interfering beliefs and cognitive distortions for a better communication. Reciprocal negotiation, communication training, problem solving techniques which are part of the cognitive-behavioural systems approach for treatment of sexual and relationship problems will be discussed. This will be an interactional workshop and participants are welcome to discuss their own cases who suffer from either sexual or relationship problems.

Workshop T9

Staying well after psychosis: A cognitive behavioural approach to relapse prevention

Andrew Gumley, Division of Community Based Sciences, University of Glasgow, Scotland

Relapse has long been associated with poor outcome for individuals with psychosis. Indeed, relapse itself can be traumatic due to the severity of distressing psychotic experiences or the involuntary procedures applied during the course of acute psychosis. A cognitive behavioural model of relapse hypothesises that the recurrence of subtle cognitive changes reminiscent of previous experiences of psychosis trigger changes in thinking and behaviour that accelerate the process of relapse. Cognitive therapy aimed at staying well after psychosis aims to collaboratively develop a case formulation of individuals’ early signs of relapse, identify the key beliefs which may drive the evolution of distress, and identify problematic safety seeking behaviours. Integral to this approach is the contribution of individuals’ experiential evidence for their relapse beliefs and the development of alternative staying well and recovery beliefs. These alternative appraisals are tested through the use of behavioural experiments and other techniques.

Who the workshop is aimed at: This is an introductory workshop for health professions involved in helping individuals with psychosis. Previous experience with CBT for psychosis is highly desirable, but it may be of interest to those considering applying cognitive therapy with psychosis.

The learning objectives: By the end of the workshop, participants will know:

  • The recent emerging evidence on the nature of cognitive behavioural risk factors for relapse in psychosis.
  • Why CBT may be an appropriate approach to address relapse risk.
  • Preliminary evidence on the effectiveness of cognitive behavioural strategies for staying well after psychosis.

Participants will have experienced:

  • Use of an ideographic case formulation approach to guide detection of relapse.
  • How this case formulation is used to guide interventions aimed at staying well after psychosis.

Teaching Methods: Lecture, dialogue, case examples, video and practical exercises using participants own clinical experiences.

Andrew Gumley is a Senior Lecturer in Clinical Psychology in the University of Glasgow. He is interested in cognitive behavioural models and prevention of relapse amongst individuals with psychosis.

Background Readings:
Gumley, A.I., O’Grady, M., McNay, L., Reilly, J., Power, K.G. & Norrie, J. (2003) Early intervention for relapse in Schizophrenia: Results of a 12-month randomised controlled trial of Cognitive Behavioural Therapy. Psychological Medicine, 33, 419-431.

Gumley, A.I. & Power, K.G. (2000) Is targeting cognitive therapy during early relapse in psychosis feasible? Behavioural and Cognitive Therapy, 28, 161-174.

Workshop T10

Applying verbal and non-verbal techniques in Skills Directed Therapy with Children and Adolescence.

Tammie Ronen, The Bob Shapell School of Social Work, Tel-Aviv University

Skills directed therapy is an integrative model that combines developmental psychology, CBT theories, constructivist theory, evidence based models and art therapy into a united intervention model for helping children change. The basic components are: Cognitive development, The role of emotion, Social development, Information processing, The role of parents. The techniques being used are verbal: Cognitive restructuring, Problem analysis, Self-control practice, as well as creative non-verbal: drawing, imagery, sculpturing, dance, music etc. Case examples, outcome data and demonstration will be presented as well.

Workshop F1

Delivering CBT self-help to a community: providing multiple access points to treatment

Lang, R, Depression Alliance Scotland and Williams, C. University of Glasgow

Background: A major funded initiative has led to the development of a self-help team to deliver and support the use of CBT self-help materials in community-based settings in Glasgow - the largest city in Scotland, UK. The team consists of 4 staff members led by a Senior Self-help Development officer. The team is tasked with working jointly with local community mental health care teams, GPs and other community based staff to both directly deliver CBT self-help written and computer-based materials, and also to familiarise, train and support front-line health care staff in the delivery of CBT self-help for depression. The self-help services are delivered both within the NHS, and also in the voluntary sector, and is jointly "owned" and led by the Health Service and Depression Alliance Scotland - the largest self-help organisation for depression in the United Kingdom. A key element of the project is the development of sustainable local user-led groups which deliver training and support in the use of CBT self-help in Depression Alliance groups.

Overall objectives: Participants will learn about the use of CBT self-help and about different ways of developing, delivering and supporting self-help treatments within community settings

Learning objectives. Those who attend will be able to:

· describe how to introduce and support CBT self-help

· summarise the key elements of the group-based self-help treatments, and have a chance to discuss how to introduce written and computer-based treatments into a service

· describe how to select which patients/clients might do best with self-help materials

· become acquainted with a range of self-help materials that address a range of common mental health problems

In addition, the workshop will describe the practical workings and development of the service - including the blocks and challenges to working in this way.

Training modalities: interactive workshop style, small group work, role play, video to watch and discuss.

Key references:

1) Lewis, G., Anderson, L., Araya, R., Elgie, R., Harrison, G, Proudfoot, J, Schmidt, U, Sharp, D, Williams C. Self-Help Interventions for Mental Health Problems. Commissioned DoH report: London. www.nimhe.org.uk/downloads/self_help.pdf

2) Lovell, K, & Richards, D. (2000) Multiple Access Points and Levels of Entry (MAPLE): ensuring choice, accessibility and equity for CBT services. Behavioural and Cognitive Psychotherapy, 28, 379-391

3) Williams, C.J., Whitfield, G. Written and computer-based self-help treatments for depression. British Medical Bulletin, 2001, 57, 133-144.

Workshop leaders: Ruth Lang is Information Officer at Depression Alliance Scotland - the largest charity addressing depression in the UK. Dr Chris Williams is a Senior Lecturer in Psychiatry at the University of Glasgow and is a Past President of BABCP. His research and clinical interest is in the area of developing and evaluating services incorporating self-help treatments .

Workshop F2

Cognitive-Behavioural Body Image Therapy for Anorexia and Bulimia Nervosa

Silja Vocks, AE Klinische Psychologie und Psychotherapie, Bochum Germany & Tanja Legenbauer, Johannes Gutenberg-Universität, Mainz Abt. Klinische Psychologie und Psychotherapie, Germany

Studies have shown that body image disturbances are a relevant factor in the development and maintenance of eating disorders. In spite of these results, interventions focusing on body image disturbances in anorexia and bulimia nervosa are rare. Therefore, we will present a treatment module aiming at the perceptual, cognitive, affective and behavioural component of a disordered body image (Cash & Hraboski, 2004; Rosen, 1997; Vocks & Legenbauer, in press).

Firstly, a model is developed helping the patient to understand the etiology and maintenance of the disorder. Furthermore, the patient is given psychoeducational information concerning body image, followed by cognitive interventions to modify dysfunctional cognitions associated with the negative body image. In this context, the sociocultural slimness ideal is questioned. The main component of the training contains body exposure to correct a distorted body image, to reduce negative emotions concerning the body and to focus on positive body parts that often have been neglected. Furthermore, the avoidance and checking behaviour in body related contexts is reduced by further exposure techniques. Additionally, patients are helped in (re)establishing positive body-related activities. Data of the evaluation of the training are presented.

References:

Cash, T.F. & Hrabosky, J.I. (2004). Treatment of body image disturbances. In J.K. Thompson, Handbook of Eating Disorders (pp.515-541). Hoboken, N.J: Wiley.

Rosen, J. (1997). Cognitive-behavioral body image-therapy. In D.M. Garner & P.E. Garfinkel, Handbook of treatment for eating disorders (pp. 188-201). New York: Guilford.

Vocks, S. & Legenbauer, T. (in press). Körperbildtherapie bei Anorexia und Bulimia nervosa. Göttingen: Hogrefe.

Workshop F3

Cognitive Behaviour Therapy for Children with OCD

Williams, T.I. Berkshire Healthcare NHS Trust, School of Psychology University of Reading, UK

The term “CBT” is used fairly broadly in relation to the treatment of OCD as elsewhere. It includes exposure with response-prevention (E/RP), in which prolonged exposure to the anxiogenic stimulus (the obsession) with prevention of the escape behaviour (i.e. the compulsion), allows the anxiety to extinguish and more adaptive coping skills to develop (Riggs & Foa 1993; Albano et al. 1995). However, a clear line cannot be drawn between E/RP and some of the more recent cognitive therapy (CT) verbal methods aimed at modifying the person’s evaluation of feared stimuli as being dangerous, and/or of ability to cope (Beck & Emery 1985; Kendall et al., 1991, 1997). In practice E/RP is accompanied by therapist's verbal statements to the effect that the feared stimulus is not dangerous, that no dreadful consequences will result from not carrying out compulsive activity, and that the person can cope, with a view to reducing distress and encouraging approach behaviours. Quantitative reviews of RCT’s of OCD in adults also suggest that pure cognitive and pure exposure interventions necessarily involve some overlapping procedures and capitalize on similar mechanisms of change (Abramowitz 1997). CT interventions of the above kind should be distinguished from those aimed at modifying appraisals involving responsibility and guilt, implicated in the recent cognitive theory of OCD (Salkovskis 1985, 2000; Rachman 1993, 1997). CT aimed at these appraisals seems to enhance treatment response.

Learning Objectives:
Participants will learn

1. how to apply cognitive behavioural principles in the treatment of OCD to children as young as 6 years of age.

2. how to measure responsibility cognitions in children from the age of ten years upwards.

Both didactic and experiential approaches to learning will be used. Discussion using case examples is encouraged.

References:
De Haan, E., Hoogduin, K., Buitelaar, J., & Keijsers, G. (1998). Behaviour therapy versus clomipramine in obsessive compulsive disorder in children and adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 1022-1029

March, J.S., Mulle, K., & Herbel, B. (1994). Behavioural psychotherapy for children and adolescents with obsessive-compulsive disorder: an open trial of a new protocol-driven treatment package. Journal of the American Academy of Child & Adolescent Psychiatry, 33, 333-341.

Salkovskis, P. M. and J. Kirk (1989). Obsessional disorders. Cognitive behaviour therapy for psychiatric problems: a practical guide. K. Hawton, Salkovskis, P.M.,

Kirk, J. and Clark, D.M. Oxford, Oxford University Press.

Workshop leader: Dr Tim Williams is a Clinical Psychologist working in the NHS with many years experience of working with children. He holds a visiting fellowship at the School of Psychology of the University of Reading has been awarded three grants for the development of cognitive behaviour therapy for children with OCD. He is currently working with Professors Salkovskis and Bolton on a new controlled trial of CBT for children with OCD. He has presented workshops at BABCP and user conferences.

Workshop F4

Identity Issues in PTSD

Brewin, C.R. Sub department of Clinical Health Psychology, University College, London

PTSD is a hybrid disorder consisting of general reactions to adversity as well as specific reactions created by exposure to extreme fear, helplessness, or horror (Brewin, 2003). Within the dual representation theory of PTSD (Brewin, Dalgleish, & Joseph, 1996), specific reactions include flashbacks and nightmares generated by a disturbance in memory encoding. These reactions are commonly treated by some variant of exposure therapy that allows trauma images to be re-encoded as episodic memories linked to a current sense of self (identity). Clinical dilemmas frequently arise when the current sense of self is fragile or predominantly negative, making exposure therapy risky. General reactions (common to other disorders such as depression) include suspiciousness, social withdrawal, and disconnection from others, as well as a profound and sometimes permanent disturbance in the sense of self. These reactions are common and are often linked to childhood adversity, a well-established risk factor for PTSD. There has been relatively little discussion of how to conceptualize and treat clients with identity disturbances.

This workshop will describe how to formulate these problems as well as putting forward a number of new treatment techniques aimed specifically at identity disturbances. The approach is based in the theory of multiple selves, whereby the self is constructed online by drawing on a variety of alternative self-representations in memory. These representations are not simply amalgams of past experience, but may also have been formed in reaction to past experiences (for example, ideal and feared selves) and in the context of relationships with attachment figures. Three types of disturbance can be distinguished: undermining of positive identities, re-establishing of unwanted negative identities, and fragmentation of identities. Unwanted negative identities commonly include the Self as helpless, incompetent, and futureless or non-existent, and the Other as abandoning, or hostile and betraying. The workshop will cover underlying theory enabling identity problems to be conceptualized, as well as new methods of assessment and treatment that involve direct interaction with different selves. This analysis has led to the development of new principles and techniques for applying a cognitive approach to repairing damage to the sense of self brought about by trauma.

Learning objectives: Participants will be able to distinguish conceptualizations of trauma reactions based on beliefs, schemas, and identities; participants will learn how to assess identity disturbances and formulate therapeutic goals based on a rebalancing of identities; participants will be able to apply new therapeutic techniques for managing predominantly negative and fragmented identities that involve direct interaction with multiple selves.

Main training modality: Didactic.

References:
Brewin, C. R. (2001). A cognitive neuroscience account of posttraumatic stress disorder and its treatment. Behaviour Research and Therapy, 39, 373-393.

Brewin, C.R. (2003). Posttraumatic stress disorder: Malady or myth? New Haven: Yale University Press.

Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). A dual representation theory of post traumatic stress disorder. Psychological Review, 103, 670-686.

Workshop leader: Chris Brewin is a Consultant Clinical Psychologist at the Traumatic Stress Clinic, part of Camden & Islington Mental Health and Social Care Trust. He is also Professor of Clinical Psychology at University College London. He has been treating and researching PTSD for over twelve years and has published widely on this topic in international peer-reviewed journals. He is an associate editor of the Journal of Traumatic Stress and member of the Board of Directors of the International Society for Traumatic Stress Studies.

Workshop F5

CBT for psychosis in routine care – interventions to aid recover

Katy Grazebrook, Salford Assertive Outreach Service

The UK’s NICE Guidelines for Schizophrenia in the “promoting Recovery Phase” recommend that psychological treatments should be available to prevent relapse, to reduce symptoms, to increase insight and to promote adherence to medication. They recommend the use of CBT and family interventions to achieve the above.

Recovery is partly about the client finding out for themselves what is useful and how to stay in “control” of their experiences. This workshop will cover three CBT interventions to aid this process. Participants will learn how to use coping strategy enhancement, relapse prevention and adherence to medication interventions in the context of an open and honest dialogue with the client about their experiences.

What is the aim? To provide some training in CBT interventions for clients with psychotic problems which can be incorporated into routine visits to clients.

The training will be skills based rather than theoretical.

Who is it for? Junior psychiatrists, Community Psychiatric Nurses, Social Workers, Occupational Therapists and Psychologists.

Level of skill: Introductory or basic CBT skills

Workshop F6

'Neither good nor bad - just perfect as you are!' - Establishing Healthy Affect Control in Clients diagnosed with Personality Disorders or Complex Trauma through the Repair of Early Attachment Problems

Herbert, C. The Oxford Development Centre Ltd, incorporating The Oxford Stress and Trauma Centre and Oxford shire Independent Psychology Service

Neuropsychological findings indicate that affect regulation is learned through secure attachment during the first year of an infant's life (Siegel, 1999; Shore, 1994, 1996). Poor affect regulation is one of the main indicators of clients, diagnosed with Personality Disorders and those having experienced early life trauma, e.g. CSA or other abuse. Hence, one of the aims for a successful treatment outcome is healthy affect control. Yet, CBT approaches for Personality Disorder, such as schema-focused therapy, or Complex Trauma do not focus on the quality of such clients' early attachment relationships, as this has been considered to be the domain of psychoanalysis or psychodynamic approaches. Herbert (2002, 2003) described a CBT-based therapeutic framework for working with complex client problems, that incorporates an assessment of the quality of early attachment relationships and, based on this, various therapeutic methods, such as imaginal re-nurturing, which aid clients to re-script and repair ruptures in clients' experiences of their early attachment relationships. Clinical practice indicates that through the use of these techniques, clients with previously very poor affect control and functionally disrupted lives, can learn to build a more secure and functionally positive sense of Self with healthy mechanisms of affect regulation.

The learning objectives for this workshop are to introduce participants to
1. the concept of attachment and its role in determining affect control,
2. a CBT-based therapeutic framework for working with clients with complex problems and 3. clinical techniques that help repair deficits in early attachment relationships to allow clients build healthy mechanisms of affect control.

The training modality will be didactic, incorporating some experiential work.

Key references:

1. Herbert, C. (2002) - A CBT-based therapeutic alternative to working with complex client problems. European Journal of Psychotherapy, Counselling & Health, 5, No. 2, 135-144.

2. Herbert, C. (2003) - "Healing the 'Inner Child' - through the Use of Imagery Re-scripting Techniques" - Invited Symposium, 4th EDMR European Association Congress – Rome.

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.

Workshop F7

Developing clinical skills in the neglected art and science of CBT for Panic and Agoraphobia.

Manley, J. West London Mental Health NHS Trust, and formerly at the Centre for Anxiety Disorders and Trauma , Maudsley Hospital, and Institute of Psychiatry, London.

Background: In comparison to research and clinical developments in other disorders, patients with Panic and Agoraphobia have recently been out of the limelight. It is thought to be an area where the model and treatment is known. However, there is a deeper level of detail to be learnt in applying the essential skills in this work than may be apparent from first viewing the panic model. Other developments in CBT for other disorders can also apply to work with panic.

Objectives: To understand the Clark (1986) model of Panic. This includes the role of hypervigilance, avoidance and safety seeking behaviours. To particularly focus on detailed skills development, emphasising the cognitive aspect of CBT treatment. To look at techniques from other disorders, such as imagery work, and imaginal exposure to traumatic memories, and how these can be useful in Panic.

Learning Objectives:
To be able to draw out the model in a dynamic and collaborative way.

To be able to prepare and then set up behavioural experiments in treatment.

Use of metaphors in treatment.

How to address common problems.

Training mode:
A didactic presentation with video, and role play exercises aimed at skills development.

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

Hackmann, A. (1998). Cognitive Therapy 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.

Presenter: John Manley is a Chartered Clinical Psychologist. After gaining the Oxford Diploma in Cognitive Therapy, from 2000 - 2003 he was an Honorary Lecturer at the Institute of Psychiatry and a clinician at the specialist Centre for Anxiety Disorders and Trauma, Maudsley Hospital, specialising in Panic and Agoraphobia, PTSD and Social Phobia. He has presented numerous workshops, including at BABCP conferences and Institute of Psychiatry conferences. He is working at the West London Mental Health NHS Trust.

Workshop F8

Psychotherapy for heterosexual couples, for gay couples and for lesbian couples: why three different therapies?

Montano A., Istituto A. T. Beck, Rome, Italy and Sungur M. Z. Department of Psychiatry, Medical School of Marmara University, Istanbul, Turkey

In this didactic workshop guidelines for psychotherapy with heterosexual couples, psychotherapy with gay couples and psychotherapy with lesbian couples will be described. Actually, three different ways of staying together need three different therapeutic approaches which are tailored according to the need of the presenting couple. And it is very important for a psychotherapist to know all of them. These issues will be discussed and the learning objective is to teach participants the differences between approaches for homosexual couples and heterosexual couples and to help them improving their skills to cope with the problems of gay and lesbian couples as well as heterosexual couples.

Key references for Mehmet Sungur (past EABCT president) and short description: please see the abstract of his workshop proposal “Couple and sex therapies”.

Key references for Antonella Montano:

Montano, A., (1999). …E la notte non rimasero divise, Mursia, Milan

Montano, A., (2000). Psicoterapia con clienti omosessuali, McGraw-Hill, Milan

Clark, D., (1997). Loving someone gay – Celestial Arts Publishing

Laird, J. & Green, R., (1996). Lesbian and Gays in couples and families, Jossey Bass

She has already established the Istituto A. T. Beck in Rome. She has been working for years on homosexuality issues and has extensive experience in clinical practice with problems of gay and lesbian couples issues. She has published many articles and three books on homosexual issues:

…E la notte non rimasero divise, Mursia 1999 (…And at night they didn’t stay apart – Publisher: Mursia)

Psicoterapia con clienti omosessuali, McGraw-Hill, 2000 (Psychotherapy with homosexual clients – Publisher: McGraw-Hill)

“Punto ‘G’, lettere dalla comunità omosessuale, Fabio Croce, 2004 (“The ‘G’ point, letters from the homosexual community – Publisher: Fabio Croce).

She has already run some workshops and contributed in symposiums in EABCT Congresses such as Istanbul and Prague.

Workshop F9

Supervision of professionals working with children and young people - issues, dilemmas and good practice

Stewart, A. and Vickers, B. Oxford City Adolescent Mental Health Service; Adolescent Assertive Outreach Team, St. George's Hospital Mental Health Trust, SW London

There has been increasing interest in the last few years in developing CBT for children and young people, however, supervision models for this age group have so far received less attention. Supervision for this age group can be complex due to the involvement of the family, and the need to take into account the developmental level of the child. In addition, the supervision process itself can mirror the therapeutic work with the child or young person; an awareness of this process is an important aspect to supervision.

A number of dilemmas and difficulties can arise in supervision, including the extent to which adult-developed cognitive models can be adapted for use with the younger age group, how to get a balance between individual work and family involvement and how to understand and deal with non-response to therapy. The supervisor plays an important role in facilitating effective cognitive therapy by addressing these dilemmas directly, as well as by modelling good practice within the supervision.

This practical workshop aims to develop the skills of participants in providing supervision for clinicians working with children/adolescents. During the workshop there will be opportunity to raise dilemmas experienced, to hear about models for supervision in this age group, to share experience with others in the workshop and to develop skills through practical exercises.

Learning Objectives:

1. To increase awareness of dilemmas and pitfalls in supervising clinicians working with the younger age group

2. To acquire knowledge of models for supervision with this age group

3. To develop skills in supervision

Teaching strategies include interactive presentation, practical exercises and discussion.

Useful references:

Padesky, C. (1996). Developing cognitive therapist competency: teaching and supervision models. In P. Salkovskis (Ed.) Frontiers of cognitive therapy , pp266-292. New York: Guilford Press

Safran, J. and Segal, Z. (1990) Interpersonal process in cognitive therapy. New York: Basic Books

Workshop leaders:
Anne Stewart
is a Consultant Child/Adolescent Psychiatrist working in Oxford, and has considerable teaching and clinical experience in cognitive therapy with young people. She has co- developed a child/adolescent component of the Oxford Cognitive Therapy Diploma Course and provides supervision and training for trainees on this course.

Bea Vickers is a Consultant Adolescent Psychiatrist who obtained her diploma from the Oxford Cognitive Therapy Diploma Course in 2000. She has had experience in supervision and training at St. Mary's Hospital and St. George's Hospital and currently provides supervision for individuals and multi-disciplinary groups both at St. George's and for the Oxford Cognitive Therapy Course

Workshop F10

Cognitive Therapy for Chronic Insomnia (including primary insomnia and insomnia that is comorbid with another psychological disorder)

Allison G. Harvey, University of Oxford

The aim of this workshop is to outline a cognitive therapy treatment for chronic insomnia (including primary insomnia and insomnia that is comorbid with another psychological disorder). Insomnia is a complex disorder of heterogeneous aetiology that can include physical disorders, substances, circadian rhythm disturbances, psychological factors, and poor sleep habits. It is the second most common psychological health problem and has serious consequences including functional impairment, work absenteeism and increased use of medical services. Further, longitudinal studies indicate 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). Despite the success of cognitive therapy for a range of psychological disorders, only recently have these approaches been applied to the treatment of insomnia. Further, few CBT training courses include a module on sleep disorders. This has resulted in many mental health professionals being unconfident in the treatment of insomnia.

Topics to be covered in the workshop include:

  • The function of sleep and sleep disorders
  • The assessment of clients with insomnia
  • The behavioural treatment for insomnia and its evidence base
  • Cognitive case conceptualization for clients with insomnia
  • The treatment of cognitive processes that maintain insomnia including: worry/rumination, monitoring for sleep-related threat, use of safety behaviours and unhelpful beliefs about sleep
  • Implications for insomnia that is comorbid with another psychological disorder

This workshop is for clinicians who have 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 (students and people hoping to pursue clinical training also welcome).

Training modalities: Teaching methods will include interactive presentation, video clips, case studies, role play and discussion.

Workshop leader: Allison Harvey is a Chartered Clinical Psychologist and University Lecturer based in the Department of Experimental Psychology and the Department of Psychiatry at the University of Oxford. She is currently directing, working as a therapist, on a study testing the efficacy of a new cognitive therapy treatment for chronic insomnia that is being conducted within the Oxford Centre for Insomnia Research and Treatment. The study is funded by the Wellcome Trust.

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 F11

Assessing, Predicting, and Overcoming Treatment Roadblocks with Complex PTSD:  Developing CBT Interventions in Accordance with Specific Trauma Characteristics

Mervin R. Smucker, Medical College of Wisconsin, Milwaukee, USA and Anne Boos, Technische Universitaet Dresden, Germany


According to a recent review of the trauma treatment outcome literature (Foa, 2003), the most effective therapies for PTSD fall into 3 treatment categories:  (1) Extensive
Exposure  (EE)  combines in vivo and imaginal exposure; (2) Extensive Exposure combined with Cognitive Therapy  (EE & CT); (3) Limited Exposure combined with Cognitive Therapy  (LE & CT).  Yet, in spite of recent advances in PTSD treatments, treatment failures and high drop-out rates continue to exist with this population.  A deficiency in the PTSD literature has been a failure to offer guidelines on how to proceed when the CBT interventions being applied are ineffective.  Moreover, no theoretical models or empirical guidelines are available to assist the clinician in deciding which of the empirically-supported PTSD category of treatment interventions are most likely to be effective with a particular client's symptoms and trauma characteristics.

This workshop is designed to: (1) aid the clinician in sorting through the various treatment interventions with clients suffering from PTSD, and (2) offer the clinician specific guidelines on how to assess, predict, and effectively address treatment roadblocks when they arise.  The presenters will offer a newly formulated trauma model that focuses on conducting an individualized, traumagraphic assessment of each trauma client, which the clinician uses to match the specific trauma characteristics of the client with the best available CBT interventions. Through lecture material, instructional videos, and case examples, the presenters will offer workshop participants a fresh new look at how to methodically integrate trauma research and empirical findings into clinical practice with this population.

Workshop participants are encouraged to bring their own case material.

Recommended Readings:
Boos, A. (2004).  Kognitive Verhaltenstherapie sequentieller Traumatisierungen:  Ein
Therapiemanual.  Hogrefe Verlag, Göttingen, Germany.

Grunert, B.K., Smucker, M.R., Weis, J., & Rusch, M.D. (2003).  When Prolonged
Exposure Fails:  Adding an imagery-based cognitive restructuring component in the treatment of industrial accident victims suffering from PTSD.  Cognitive and Behavioural Practice.

Smucker, M.R., Grunert, B.K., & Weis, J.M. (2003).  Overcoming roadblocks in
cognitive-behavior therapy with PTSD:  A new algorithm treatment model.  In R.L. Leahy (ed.) Overcoming Roadblocks in Cognitive Therapy.  Guilford Publications: New York.

Mervin R. Smucker, Ph.D. is Associate Clinical Professor in the Department
of Psychiatry at the Medical College of Wisconsin, where he conducts trauma
treatment outcome research. He is also Clinical Director of the Trauma
Treatment Program at Columbia-St. Mary's Hospital in Milwaukee, Wisconsin. Dr. Smucker is the author of several books on imagery-based CBT for trauma victims. His
most recent publications include several articles on a new algorithm treatment model for PTSD.



Workshop F12

Cognitive-behavioural therapy for generalized anxiety disorder: Learning to tolerate uncertainty and emotional arousal

Dugas, M. J. Concordia University and Hôpital du Sacré-Coeur de Montréal

Abstract: Although Generalized Anxiety Disorder or GAD is one of the most common anxiety disorders, empirically-supported treatments for GAD are just beginning to emerge. This workshop will present a cognitive-behavioural treatment for GAD that has been tested in two controlled clinical trials. The treatment is based on the idea that individuals with GAD are both intolerant of uncertainty and intolerant of emotional arousal. Unfortunately, attempts to avoid uncertainty often lead to emotional arousal whereas attempts to avoid emotional arousal often lead to uncertainty. Individuals with GAD, therefore, are “trapped” between two opposing tendencies. The treatment addressed these opposing tendencies by teaching patients to seek out uncertainty and emotional arousal in the problem-solving process and confront uncertainty and emotional arousal during cognitive exposure to core fears. Workshop participants will receive an electronic copy of a treatment manual describing each step of the treatment.

Learning Objectives: Participants will learn:

1. how to conceptualize GAD as the result of opposing tendencies to approach and avoid;

2. how to incorporate uncertainty and emotional arousal into problem-solving training;

3. how to develop cognitive exposure scenarios that reflect core fears and contain elements of uncertainty;

4. how to address perceived secondary gains resulting from GAD symptoms.

Training Modalities:
Experiential (e.g., role play) and didactic methods will be used.

Key References:
1. Dug as, M. J., Adducer, R., Legers, E., Frees ton, M. H., Lang lois, F., Provence, M. D., & Boise, J. -M. (2003). Group cognitive-behavioural therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up. Journal of Consulting and Clinical Psychology, 71, 821–825.

2. Dugas, M. J. (2002). Generalized anxiety disorder. In M. Hersen (Ed.), Clinical behaviour therapy: Adults and children (pp. 125-143). New York: John Wiley & Sons.

3. Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized Anxiety Disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215-226.

Workshop Leader: Dr. Michel J. Dugas is Associate Professor in the Department of Psychology at Concordia University and Clinical Psychologist at the Anxiety Disorders Clinic of Sacré-Coeur Hospital of Montreal. Over the past 12 years, he has been conducting research on worry and generalized anxiety disorder (GAD), which has lead to the development and validation of a cognitive-behavioural model and treatment of GAD. The treatment has already been tested in two randomised clinical trials, both of which were funded by the Canadian Institutes of Health Research. A third trial is currently underway, comparing the treatment to other psychosocial treatments for GAD. Dr. Dugas has been very active in the areas of research and training, with workshop presentations closely tied to the findings of his research program.

Workshop F13

Disseminating CBT skills across the workforce: a training programme in equipping non-specialist clinicians in delivering protocol based CBT interventions.

Chris Williams, Glasgow, Scotland and Anne Garland, Nottingham

A major challenge facing those involved in CBT training is how to deliver appropriate skills-based training in CBT to non-specialist clinicians. Any training model must provide an approach that retains the strengths of CBT – its structure, focus on current clinical problems and relationship with the practitioner/patient, yet at the same time can be offered in limited time and can be applied flexibly across the range of clinical settings. This workshop is based on a major UK training initiative aimed at addressing this training need by seeking to integrate core CBT skills into generic clinical practice. The course has clear aims - not to create mini CBT experts, but instead to enable practitioners to assess patients using a CBT model, and to offer focused CBT self-help interventions. Over 200 practitioners have now been trained in this course and a strong evidence base confirms sustained gains in subjective and objective knowledge and skills in working using self-help with clients/patients.

Those attending the training day will:

  • Gain a detailed overview of the self-help training course
  • Have a clear understanding of the evidence base for the use of a broad range of CBT self-help materials
  • Gain generic skills in using written self-help materials
  • Be able to describe different models of delivering self-help in both primary and secondary care settings
  • Understand how to select people for self-help treatments
  • Gain an overview of how to deliver this form of treatment in their own local settings including how to anticipate and manage obstacles to implementing such an initiative.

About the workshop leaders:

Chris Williams is Senior Lecturer at the University of Glasgow. He is a Past-President of the British Association for Behavioural and Cognitive Psychotherapies (BABCP).

Anne Garland is a Consultant Nurse in Psychological Therapies in Nottingham and a well-known CBT trainer and researcher.

Workshop S1

Workshop S2

Making CBT meaningful for people with intellectual disabilities: from theory to practice.

A.G.Jahoda & D. J. Dagnan University of Glasgow, University of Northumbria in Newcastle

A recent survey of psychologists working with people with mild to moderate learning disabilities found that the majority professed to be using CBT type approaches for a variety of emotional and inter-personal difficulties. However, there was a lack of confidence that their practice was sufficiently standardised or of a high enough standard to be described as CBT. Yet the heterogeneous nature of people's intellectual disabilities necessitates retaining flexibility and maintaining an individual focus to the work. A further issue concerns the particular social experience of people with learning disabilities, and taking seriously the role of factors such as stigma in therapy. The aim of this workshop is to highlight the importance of the inter-personal context of therapy, and to identify ways of making CBT meaningful and relevant to the everyday lives of people with learning disabilities.

Learning Objectives:

1. To identify possible barriers to engagement in therapy, and consider ways of establishing a shared frame of reference between client and therapist.

2. Examining the how the particular social experience of people with learning disabilities can contribute to their emotional distress, and suggesting ways of taking the wider context of their lives seriously in therapy.

Participatory workshop.

Suggested references:

Beail, N. (2003). What Works for People With Mental Retardation? Critical Commentary on Cognitive-Behavioural and Psychodynamic Psychotherapy Research. Mental Retardation, 41, 468-472.

Stenfert-Kroese, B, Dagnan, D. & Loumidis, K. (1997). Cognitive behavioural therapy for people with learning disabilities. London: Routledge.

Lindsay, W.R., Howells, L. & Pitcaithly, D. (1993). Cognitive therapy for depression with individuals with intellectual disabilities. British Journal of Medical Psychology, 66, 135-141.

Workshop Leaders: Andrew Jahoda and Dave Dagnan work clinically and teach other professionals in the area of cognitive therapy. Andrew Jahoda is a lecturer at Glasgow University and a Consultant Clinical Psychologist with the Glasgow Learning Disability Partnership. Dave Dagnan is a Consultant Clinical Psychologist and Clinical Director at the Learning Disability Services in North Cumbria.


Workshop S3

Cognitive Behaviour Therapy for Bipolar Disorder

Steven Jones, University of Manchester & John McGovern, University of Manchester

Bipolar disorder is a common and severe mental health problem. It is associated with high risk of suicide and self harm and several studies have indicated that the course of the disorder tends to worsen with age. Until quite recently the primary focus for treatment has been psychopharmacological. However there is now a developing literature to indicate the important role that psychological, especially cognitive behavioural, interventions have for the treatment of people with bipolar disorder which will be reviewed as part of this workshop.

The key features of CBT for bipolar disorder will be presented, based on the therapy manual developed by Lam, Jones, Hayward and Bright (1999) and on more recent work, including factors associated with intervening with clients who have only recently been diagnosed with bipolar disorder.

The workshop will cover issues of engagement in therapy of these potentially challenging clients; the importance of clients learning to identify normal and abnormal mood fluctuations; the importance of realistic mood targets; working with positive and negative automatic thoughts; identifying prodromes and prodromal coping strategies; and working with long term vulnerabilities. The focus of these techniques will be towards providing clients who are current experiencing subsyndromal symptoms with skills which will significantly impact on relapse risk and current functioning. Case vignettes and group work will be used to illustrate these issues and practice particular techniques.

The workshop is aimed at: Clinical professionals with some experience of CBT techniques.

The learning objectives:
To be aware of the vulnerability-stress model of bipolar disorder and more recent developments
To understand the concept of a continuum of bipolar experience
To understand the key diagnostic features of bipolar disorder and associated issues
To be aware of the factors associated with illness course and onset
To understand key factors associated with the application of cognitive therapy to clients earlier in the illness course
To understand the key features of a cognitive behavioural approach including: i)mood and activity monitoring ii)identification of prodromes iii) dealing with long term vulnerabilities

The teaching methods: Lecture, video, case examples and discussion

Workshop leaders: Steven Jones is Senior Lecturer in Clinical Psychology and Academic Director of the Doctorate in Clinical Psychology, University of Manchester. He has a long standing interest in the cognitive aspects of severe and enduring mental illness in general and bipolar disorder in particular. He has published theoretical and research papers concerning the psychopathology of bipolar disorder and its treatment by cognitive behaviour therapy. His clinical work, based at Pennine Care NHS Trust, also specializes in the psychological treatment of people with bipolar disorder.

John Mc Govern is a Consultant Clinical Psychologist/Lecturer - Cheshire & Wirral NHS Trust/School of Nursing, Midwifery & Health Visiting, University of Manchester. He has a longstanding interest in CBT treatment approaches for psychotic disorders and continuum models of psychopathology with publications in this area. He was course director of an MSC in CBT for Psychoses at the University of Manchester. His clinical work in a low secure unit allows him to use CBT work with bipolar patients who also have a forensic profile.

Background readings:
Jones, SH, Hayward, P & Lam, DH (2002). Coping with Bipolar Disorder. Oneworld Lam DH, Jones, S.H., Hayward, S & Bright, JA (1999)

Cognitive Therapy for Bipolar Disorder: A Therapist's Guide to concepts, methods and practices. Wiley & Son, London.

Lam, D.H., Bright, J., Jones, S., Hayward, P., Schuck, N., Chisholm, D., & Sham, P. (2000). Cognitive therapy for bipolar disorder: A pilot study of relapse prevention. Cognitive Therapy and Research, 24, 503-520.

Workshop S4

Motivational Interviewing: Revisiting the basics

Henck van Bilsen, Kneesworth House Hospital & Auckland Institute for Cognitive and Behaviour Therapies, Auckland New Zealand

This workshop is of interest to professionals who have an interest in motivational interviewing, working with sceptical and challenging clients. No prior knowledge of the subject is needed, but having a clinical practice to draw on will be an asset.

Learning Objectives:

  • Recognising Stages of Change
  • Adapting Interventions to the Stages of Change
  • Basic Motivational Interviewing Techniques (SAL, Conflict Reflections, Feeling Reflections))
  • Advanced Motivational Interviewing Techniques (Fine-tuning, Provocing, Columbo, Positive Restructuring)

Training Modalities: Each topic will be introduced by a brief lecture, followed by experiential exercises and/or demonstrations by the tutor.

References:

  • Prochaska, J.O. & DiClemente, C.C. (1984. The transtheoretical approach: crossing the traditional boundaries of therapy, Malabar, FL: Krieger
  • William R. Miller & Rollnick, S. (2002) Motivational Interviewing: Preparing people for change, The Guilford Press, New York
  • Van Binsbergen, M.H. (2003) Motivatie voor Behandeling, Garant, Anwterpen, Belgium
  • Van Bilsen, H.P.J.G. (2004) Going slow is going fast: the orchestration of change in an immoveable world (a practical guide for the application of motivational strategies), AICBT, Auckland, New Zealand (available through author from May 2004)

Workshop leader: Henck van Bilsen is a consultant clinical psychologist working with personality-disordered patients in Kneesworth House Hospital, a medium secure facility in Royston. He is also a director of the Auckland Institute for Cognitive and Behaviour Therapies in New Zealand. He has been involved in learning and training motivational interviewing from ‘almost the beginning’. He has worked in the Netherlands, the UK and New Zealand. He has very engaging teaching style.

Workshop S5

Cognitive Behaviour Therapy for Body Dysmorphic Disorder

David Veale, The Priory Hospital North London and Royal Free & University College Medical School, London and Fugen Neziroglu Bio-Behavioral Institute in Great Neck, New York

Body Dysmorphic Disorder (BDD) is defined as a preoccupation with an “imagined” defect in one’s appearance. Alternatively, where there is a slight physical anomaly, then the person’s concern is markedly excessive. The preoccupation is associated with a distorted body image with many time consuming safety behaviours such as mirror gazing, camouflaging or constant comparing of oneself to others. Such patients have a poor quality of life, are socially isolated, often depressed and are at high risk of committing suicide. They often have needless dermatological treatment and cosmetic surgery. Cognitive behaviour therapy offers a promising treatment.

Learning Objectives: By the end of the workshop participants will:

1. Recognize and diagnose various forms of BDD

2. Understand a cognitive behavioural model of BDD and the factors that maintain the symptoms of BDD

3. Use various assessment scales

4. Learn how to try deviating a client from cosmetic surgery and dermatological treatments

5. Devise strategies for engagement and change in BDD

6. Have the opportunity to discuss their own cases

Training modalities: The workshop will be interactive and include both experiential and didactic teaching and videos.

Key references

1. Neziroglu, F. & Khemlani-Patel, S. Therapeutic approaches to body dysmorphic disorder. Brief Treatment and Crisis Intervention, 3(#), 2003.

2. Veale, D. Advances in a cognitive behavioural model of body dysmorphic disorder. Body Image, 2003, 1

3. Veale, D. Cognitive Behaviour Therapy for Body Dysmorphic Disorder. In Castle, D.J. & Phillips, K.A. (Editors): Disorders of Body Image (pp.121-138). Wrightson Biomedical Publishing Ltd: Petersfield, England, 2002

4. Yaryura-Tobias, J.A. & Neziroglu, F. Obsessive Compulsive Disorder Spectrum: Pathogenesis, Diagnosis and Treatment. Washington DC: American Psychiatric Press, 1997.

Workshop leaders: David Veale, FRCPsych is a Consultant Psychiatrist at The Priory Hospital North London and a Hon Senior Lecturer at the Royal Free & University College Medical School, London. He sits on the development group for NICE that is preparing guidelines for the treatment of OCD and BDD. He is Associate Editor of the journal “Body Image” and a professional adviser to the user group OCD Action, which has many members with BDD.

Fugen Neziroglu, PhD is a board certified behavioural psychologist and Clinical Director of Bio-Behavioral Institute in Great Neck, New York. She is full professor at Hofstra University and New York University and is on the scientific advisory board of the Obsessive Compulsive Foundation. She has written over 100 scientific papers and eight books on obsessive compulsive spectrum disorders, including body dysmorphic disorder. She is on the editorial board of several journals including “Body Image”.

Workshop S6

Exposure to the imaginative death experience in hypochondriasis

Prasko J. 1,2,3); Paskova B. 1,2,3); Praskova H. 4)

  • Prague Psychiatric Centre, Czech Republic; 2) 3rd Medical faculty of Charles University, Prague, Czech Republic; 3) Centre of Neuropsychiatric Studies, Prague, Czech Republic; 4) Out-patients Psychiatric Clinic, Horni Palata, Prague, Czech Republic

Abstract:

Patients with health anxiety are often unable to describe concrete consequences of their putative somatic diseases. They block their thoughts due to the accompanying strong anxiety. Sometimes health-anxious patients try not to think about illness at all, by attempting to control their thoughts or by distraction. Our method is based on therapeutic dialogue, using Socratic questioning, and inductive methods which force the patient to think beyond the actual blocks. Patients are asked to think out all other possibilities of their newly discovered future. They are forced to imagine the worse consequences of all feared situations. Dialogue is led through one’s serious illness status, with its somatic, psychological and social consequences, and the dying experience to the moment of death, which has to be described with all related emotions and details. We also ask patients to imagine possible "after death experiences". In the next session the patient brings a written conception of the feared situations previously discussed. We work with this text as in imaginative exposure therapy. We have observed that gradual habituation after several sessions leads to remarkable release of anxiety symptoms, safety and avoidant behaviors.This method seems to be quite effective and not too time-consuming. Several patients with health anxiety underwent this exposure in our therapeutic groups. All of these patients profited from this therapy, as confirmed by follow-up data. Participants will learn: - conceptualization of health anxiety with the patient; - Socratic questioning with the hypochondriacal patient; - how to apply the exposure to the imaginative death experience.

Jan Prasko, MD, PhD.
- Head of the 1st Clinic Department of the Prague Psychiatric Centre
- Past President of the EABCT
- Therapeutic work with patients suffering from anxiety and
depression, and with hypochondriacal patients
- Lecturing at the 3rd Medical Faculty of Charles University in Prague
- Leader, trainer and supervisor of several therapy training programs in the Czech Republic and the Slovak Republic
- Principal investigator of many research studies
- Author of 13 scientific monographs, 19 textbooks, and 43 handbooks

Beata Paskova, MD
- Therapeutic work with patients suffering from anxiety and
depression, and with hypochondriacal patients
- Lecturing at the 3rd Medical Faculty of Charles University in Prague
- Investigator of many research studies
- Author of 2 scientific monographs, 3 textbooks, and 11 handbooks

Hana Praskova, MD
- Therapeutic work with patients suffering from anxiety disorders
- Lecturing at the 1st Medical Faculty of Charles University in Prague
- Author of 3 scientific monographs, 5 textbooks, and 14 handbooks

Supported by the research grant CNS LN00B122 from Ministry of Education, Youth and Sports, the Czech Republic and by the research grants IGA NF/7565-3 and IGA NF/7580-2.

Workshop S7

CBT for anxiety/depression in patients with the diagnoses Asperger and AD/HD

E. Ekman, Gothenburg center for Cognitive Behavioural Therapy - GKB, Private Practice

Workshop: In the treatment of patients with Asperger (AS) and AD/HD is it important to understand the difficulties the handicap involves in order to recognize the problem as well as knowing how to implement the relevant treatment.

In the treatment with anxiety- and depressed patients, we sometimes fail, even though we use the treatments that has shown to have good prognoses according to research and should be effective. This can sometimes be due to the fact that we have failed to recognise the diagnoses of AS or ADHD or we have not had enough knowledge about the problem involved in this handicap.

There is extensive research being done on AS and AD/HD some of which were presented at The Social Brain Conference in Gothenburg, Sweden in March 2003 and our knowledge and understanding of AS and AD/HD have increased, but there are few if any studies made on patients with this handicap that suffers from anxiety disorder or depression.

I will present basic knowledge about the handicap and how one as a CBT therapist can become better in the treatment for these patients.

In the work with the anxiety and the depression the therapist has to know how to communicate to the individual with these handicap about there problems, how to help the person practice and do homework. The therapist has to be able to understand the difference in working with patients with these handicap and the ones without the handicap.

Workshop format:

Basic knowledge about AS and AD/HD (15 min)

What does these problems mean (15 min)

Case examples (10 min), Exercise (10 min)

How do the therapist differentiate between OCD and the Asperger person difficulty in creating functional routines. (5 min)

How do you help the person with AS or AD/HD to lower and handle the

Anxiety (15 min), Exercise (10 min)

How can one help the patient with AS or AD/HD to deal with their negative

thoughts and /or low self esteem. (15 min), Exercise (10 min)

How should I give homework and how can I do exposure. (15 min),Exercise (10 min)

Questions and Summary (10 min)

References: LIc. Psych. Ulla Wattar, Copenhagen, Denmark. Member of SAKT

Dr. Christ er Northland , Gothenburg, Sweden . Member of BTF

Laic. Psych. Per Bordello, Abram, Sweden , . Member of BTF

Workshop S8

Cognitive Therapy for post traumatic stress disorder in the context of civil conflict using the Ehlers Clark Cognitive model of PTSD

Gillespie, K. & Duffy, M, The Northern Ireland Centre for Trauma & Transformation, Northern Ireland

In August 1998 a car bomb exploded in the market town of Omagh, Northern Ireland killing 29 people and two unborn children. The bombing was carried out by an illegal paramilitary organisation that rejected the political settlement, which had been agreed just four months previously.

Following the explosion the local public health and social services organisation established a multi-disciplinary community trauma and recovery team to respond to the needs of the Omagh community. Over the following three and a half years the team treated or supported over 670 people (including children). When the team closed a new charitable body, called The Northern Ireland Centre for Trauma & Transformation (NICTT), was formed to harness and build upon the learning and skills developed by the original team in treating psychological trauma. The Centre works in the context of a civil conflict and its primary treatment objectives are to treat people who have been traumatised by violence associated with the civil violence in Northern Ireland.

This workshop will present the original trauma team’s experience of applying the Clark Ehlers (2000) cognitive therapy treatment model for PTSD and an audit of its effectiveness. The paper will also provide an update on how the model has continued to evolve and is currently applied within the NICTT, and include video recorded case examples. It is expected that preliminary findings from a randomly controlled trial of the treatment approach, currently underway, will be presented.

Workshop S9

Collaborative Interviewing in Mathematical Analogy Technique (CLIMATE): socializing the patient into CT using a step by step analysis and synthesis technique

Konstandinidis L. & Simos G. Community Mental Health Centre/ 2nd Dept. of Psychiatry, Aristotelian University of Thessaloniki, Thessaloniki, Greece

Socializing and educating the patient about the cognitive model and also the nature of his problem is a very important step of treatment. For some patients it may actually be the first time they have a good chance to understand their problems and see them through a very different and meaning making perspective. At the same time the therapist installs hope and consequently enhances a given patient’s necessary motivation and willful collaboration for treatment. Quite often, during this socialization phase of therapy, cognitive therapists briefly describe the cognitive model and recommend relevant bibliotherapy. Is this enough? Although there are plenty of different cognitive techniques for different major or minor interventions, there is a relevant paucity in techniques corresponding to the early socialization phase in CT. Motivational techniques are also rarely used in this early phase of treatment.

In order to achieve such a) a successful socialization into CT, b) a patient’s motivation for therapy, and c) recruitment of his best possible collaboration, we developed CLIMATE. CLIMATE is a step by step analysis and synthesis procedure where a mathematical analogy is used as a vehicle for this purpose. Socratic questioning predominates, while a deductive process leaves ample room for the aspect of collaborative empiricism. CLIMATE uses a set of specific steps, is highly structured, it takes approximately 15 minutes and it has been applied to a sample of more than 300 patients. Objective of this mini-workshop is to help participants adopt this technique as a part of their everyday clinical practice. Appropriate revisions are also presented for difficult patients. Since CLIMATE does not also help patients, but it also gives the therapist some clues on the patient's attitudes towards their problems and therapy, preliminary results are also presented on the CLIMATE's predictive value for subsequent non-compliance and early drop-outs from treatment.

References:
Burns, G. W. (2001). 101 Healing Stories, using metaphors in therapy. Wiley, Chichester

D' Zurila, T. G. (1988). Problem Solving Therapies. In K. S. Dobson (ed) Handbook of Cognitive - Behavioural Therapies. Guilford Press, New York.

Polya, G. (1957). How to solve it (2nd edition). Princeton University Press, NY.

Lefteris Konstandinidis, MA and Gregoris Simos, MD,PhD are members of the Greek Association for Cognitive and Behavioural Psychotherapies.