Pre-Conference Workshops.

Wednesday 16th July

A programme of 20 one-day Workshops will be held on Wednesday 16th July on the day before the Conference. The workshops will begin at 9:30 and finish at 17;00. These workshops, many of them by internationally recognised experts, offer participants an opportunity to develop practical skills in the assessment and treatment of a range of areas. A description of each workshop is available below and you can register using the application form also found on this website. The number of places available is limited so early application is advised to avoid disappointment.


Child and Adolescent Issues

Workshop 1

Introduction to CBT skills for mental health professionals/practitioners working with children, young people and families
Nicky Dummett, and Kath Davies, Child and Adolescent Mental Health

Workshop 2

Triple P-Positive Parenting Program: A multilevel population strategy as an abuse prevention strategy
Matthew R Sanders, Parenting and Family Support Centre, School of Psychology, The University of Queensland, Australia

   
Therapeutic Issues
Workshop 3

Cognitive Therapy and the Self. If I don't know who I am, how can I know what I think?
Gillian Butler, Warneford Hospital, Oxford and Oxford Cognitive Therapy Centre.

Workshop 4 Overcoming Roadblocks in Cognitive Therapy
Robert L. Leahy, American Institute for Cognitive Therapy, NYC and Weill-Cornell Medical School, USA
Workshop 5 Nutrition: its effect on Mental Health, and the implications for Cognitive Therapy
Nigel Mills, University of Swansea
Workshop 6 Expressive writing as a therapeutic method
James W. Pennebaker, The University of Texas at Austin, USA
   

Behavioural Medicine

Workshop 7 Cognitive Behavioural Treatment of Somatic Complaints in Children and Adults
Trudie Chalder, Guy's, Kings and St Thomas' School of Medicine and Anne Speckens, Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Trust
Workshop 8 Exposing fear of pain: Tackling avoidance in clinical setting
Zoë Clyde, Annie Moreland, Jannie Van der Merwe, and Rachel Vickers. INPUT Pain Management Unit, St Thomas' Hospital, London
Workshop 9 Coping with Adversity: Cognitive Therapy in Adverse Life Situations.
Stirling Moorey, South London and Maudsley Trust
   
Applied Issues
Workshop 10 Setting up and delivering written and computer based self-help packages within a clinical service.
Christopher Williams and Graeme Whitfield, Division of Community-based Sciences, University of Glasgow.
   

Issues in Psychosis

Workshop 11

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

Workshop 12 Trauma and Psychosis: Cognitive Theory and Therapy
Anthony Morrison, University of Manchester, Douglas Turkington, Royal Victoria Infirmary, Newcastle-upon-Tyne, Warren Larkin, IMPACT Service, Bolton, Salford & Trafford Mental Health Trust & Pauline Callcott, Newcastle CB Psychotherapy Centre
Workshop 13 Early Intervention in Psychosis: What kind of interventions and for whom?
Jo Smith, Worcestershire Mental Health Partnership NHS Trust
   

Adult Mental Health

Workshop 14 Unipolar and Bipolar Depression: Similarities and differences
Jeny Bright and Ruth Williams, Institute of Psychiatry, London
Workshop 15 Transdiagnostic CBT for eating disorders
Christopher G Fairburn, University of Oxford
Workshop 16 Exposure therapy to cognitive restructuring within/outside of reliving: A skills based workshop to build on basics in PTSD therapy
Deborah Lee and Kerry Young, Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care NHS Trust and University College London
Workshop 17 Basics of behavioural activation treatment for depressed adults.
Christopher R. Martell, University of Washington, USA
Workshop 18 Exposure Across Anxiety Disorders: Overcoming Resistance and Refining Approaches.
Christine Purdon, University of Waterloo, Ontario, Canada
Workshop 19 The paradox of thought control: Cognitive therapy for obsessive-compulsive disorder
Maureen L. Whittal, Anxiety Disorders Unit, UBC Hospital, Canada
Workshop 20 Mindfulness-based Cognitive Therapy for Depression: a new approach to preventing relapse
Mark Williams, University Department of Psychiatry, Warneford Hospital Oxford

Workshop 1

Introduction to CBT skills for mental health professionals/practitioners working with children, young people and families.

Nicky Dummett, and Kath Davies, Child and Adolescent Mental Health Services , Yorkshire.

Who the workshop is aimed at: Child and adolescent mental health professionals/practitioners with some CBT experience but who have not undergone a formal (e.g. year-long) training course.

The learning objectives:
• For workshop participants to be able to devise a cognitive behavioural formulation for cases they see,
• For workshop participants to develop a socratic questioning style to carry out this process and underlie a collaborative therapeutic relationship,
• For all involved in the workshop to share together ideas and experience of using CBT with children, young people and families

Teaching Methods: Lecture and experiential techniques (e.g. roll play, modelling, "in-session" behavioural experiments).

Nicky Dummett, Consultant Child Psychiatrist and UKCP registered cognitive-behavioural therapist, and Kath Davies, Consultant Clinical Psychologist, have extensive experience of CBT with children and young people and also of teaching fellow professionals and students. We deliver regular CBT training to CAMHS professionals within Yorkshire, including a year-long introductory course in CBT with children, adolescents and families.

Background readings:
1. Ronen, T (1997). Applying Cognitive Techniques to Children, chapter 9 in: Cognitive Developmental Therapy with Children. Pub: Wiley + Sons, Ltd.
2. Greenberger, D and Padesky, C (1995). Understanding Your Problems, chapter 1 in: Mind Over Mood: a Cognitive Therapy Treatment Manual for Clients. Pub: Guilford, New York.
3. Padesky, C (1993). Socratic Questioning: Changing Minds or Guiding Discovery? Keynote address delivered at the European Congress of Behavioural and Cognitive Therapies, London, September 24.
4. Stallard, P (2002). Cognitive Behaviour Therapy with Children and Young People: A Selective Review of Key Issues. Behavioural and Cognitive Psychotherapy, 2002, 30, 297-309.


Workshop 2

Triple P-Positive Parenting Program: A multilevel population strategy as an abuse prevention strategy.

Matthew R Sanders, Parenting and Family Support Centre, School of Psychology, The University of Queensland, Australia

Who the workshop is aimed at: Psychologists, psychiatrists, social workers, family counsellors, school guidance officers, parent educators, nurses and other allied health professionals with knowledge of CBT.

The learning objectives: This program 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 and more recently has been extended to include strategies focusing on the prevention of child maltreatment. 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 discuss 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.

Teaching Methods: Lecture, DVD, active skills training, problem solving exercises and group discussion

Professor of Clinical Psychology Matthew R Sanders is the founder of the Triple P-Positive Parenting Program, is director of the Parenting and Family Support Centre. This internationally recognized program has twice won the National Violence Prevention Award from the Commonwealth Heads of Government in Australia. He conducts research in the area of parenting, family psychology and the treatment and prevention of childhood psychopathology. Professor Sanders has published extensively on the nature, causes, prevention and treatment of behavioural disturbance in children. In 1996 he was awarded a Distinguished Career Award from the Australian Association of Cognitive Behaviour Therapy.

Background readings:
1. Sanders, M. R. (1999). The Triple P-Positive parenting program: Towards an empirically validated multilevel parenting and family support strategy for the prevention of behavior and emotional problems in children. Clinical Child and Family Psychology Review, 2, 71-90.
2. Sanders, M. R., Markie-Dadds, C., Tully, L., & Bor, W. (2000). The Triple P- Positive Parenting Program: A comparison of enhanced, standard, and self directed behavioral family intervention. Journal of Consulting and Clinical Psychology, 68, 624-640.
3. Bor, W., Sanders, M. R., & Markie-Dadds, C. (2002). The effects of The Triple P-Positive Parenting Program on Pre-School Children with co-occurring disruptive behavior and attentional/hyperactive difficulties. Journal of Abnormal Child Psychology, 30(6), 571-587.


Workshop 3

Cognitive Therapy and the Self. If I don't know who I am, how can I know what I think?

Gillian Butler, Warneford Hospital, Oxford and Oxford Cognitive Therapy Centre.

Who the workshop is aimed at: Experienced practitioners who are familiar with using cognitive therapy in the treatment of complex cases.

Learning Objectives: The aim of this workshop is to present a collection of ideas and methods for helping people to develop their sense of identity using cognitive therapy. The material presented is the product of clinical observation working with people who have suffered extensive childhood trauma. It is not, yet, based on research findings. By presenting ideas at this stage I hope to continue the process of broadening the perspective of cognitive therapy, and to help the participants to develop specific skills that will help these people, and others with similar problems. More specific aims of the workshop are:
• to raise issues of definition and formulation
• to increase understanding of the problems arising when someone has a poorly developed, or apparently dysfunctional, sense of identity
• to present a range of methods that potentially helps people to develop a more functional sense of self.

This work is understood as a pre-requisite for, or complement to, work on self-esteem. It overlaps with it, but not entirely. An additional aim is to stimulate thought and discussion about the issues raised

Teaching Methods: Interactive methods of all kinds will be used, including discussion, workshop exercises and role-play.

Gillian Butler works both for the NHS and for The Oxford Cognitive Therapy Centre (OCTC). Her main clinical interest is in the use of CBT during recovery from traumatic experiences in childhood. She regularly runs training workshops on a wide variety of topics relevant to practitioners of CBT, in this country and overseas. She is co-author of Manage Your Mind and the author of Overcoming Social Anxiety and Shyness

Background reading:
1. Linehan, M. 1993, CBT for Borderline Personality Disorder. New York, Guildford.
2. Hayes, S., Strosahl, K.D. & Wilson, K.G.1999. New York, Guilford.
3. Leahy, R. 2002. Cognitive therapy: current problems and future directions. In R.L. Leahy & E.T. Dowd (Eds.), Clinical Advances in Cognitive Psychotherapy, New York, Springer.


Workshop 4

Overcoming Roadblocks in Cognitive Therapy

Robert L. Leahy, American Institute for Cognitive Therapy, NYC and Weill-Cornell Medical School, USA

Experienced therapists recognize that patients often do not adhere to the general plan of cognitive behavioural therapy. In this workshop, we will examine four areas of roadblocks, non-adherence, non-compliance or resistance. Our first focus will be on non-compliance with CBT "Procedure". This will include overcoming roadblocks in completing homework, agenda setting, continuity in treatment, and abusive behaviour toward the therapist. Our second focus will be on demands and assumptions for validation and helping patients identify the meaning of invalidation and change. A third focus will be on emotional processing, including the patient's emotional schemas and emotional regulation. Finally, we will examine how the therapist's own personal schemas may be activated and can either interfere with therapeutic collaboration or enhance developing insights into the patient's interpersonal world. For each of these roadblocks we will utilize case conceptualisation, negotiation for change, specific interventions, and the role of the therapist's assumptions that may contribute to impasses.

Robert L. Leahy, Ph.D., is the President-Elect of the International Association of Cognitive Psychotherapy, Editor of the Journal of Cognitive Psychotherapy, Director of the American Institute for Cognitive Therapy in New York City, Clinical Professor in the Department of Psychiatry at Weill-Cornell Medical School, and author or editor of twelve books including Overcoming Resistance in Cognitive Therapy, Practicing Cognitive Therapy: A Guide to Interventions, Treatment Plans and Interventions for Depression and Anxiety Disorders (with S. Holland), Bipolar Disorder: A Cognitive Therapy Approach (with Newman, Beck, Reilly-Harrington, and Gyulai, L.).,Psychology and the Economic Mind, and CognitiveTherapy Techniques: A Practitioner's Guide.

Background reading:
1. Leahy, R.L. (2001) Overcoming Resistance in Cognitive Therapy. New York: Guilford.
2. Leahy, R.L. Strategic self-limitation. Journal of cognitive psychotherapy, 1999 13, 275-293
3. Leahy, R.L. Sunk-costs and resistance to change. Journal of cognitive psychotherapy, 2000, 14.
4. Leahy, R.L. (1996) Cognitive Therapy: Basic Principles and Applications. Northvale, NJ: Jason Aronson. Pp. 191-230.
5. Leahy, R.L. (Ed.) (2003) Overcoming Roadblocks in Cognitive-Behavioral Therapy. New York: Guilford.

 


Workshop 5

Nutrition: its effect on Mental Health, and the implications for Cognitive Therapy

Nigel Mills, University of Swansea

There is now a substantial evidence base to show that changes in nutritional intake have an effect on mental health. The effects of caffeine; refined sugar, food additives; folic acid; fatty acids and Vitamin B12 have all been shown, in well-controlled studies, to have significant effects on mental health. Despite this evidence-base, mental health professionals rarely ask about nutritional intake and NHS day, and in-patient units, persist in serving regular doses of caffeine and refined sugar.

The aim of this workshop is to outline the evidence base for the effect of nutrition on mental health and to provide participants with a 'decision tree' to help them ascertain whether nutritional issues are likely to be involved in a particular case. Are there particular styles of maladaptive cognitions that may alert one to a potential nutritional involvement? The workshop will provide participants with an opportunity to explore real case material. The use of motivational interviewing as an appropriate style, in which the issue of nutrition can be brought up within cognitive therapy will be an experiential focus.

Learning Objectives:
At the end of the workshop participants will be able to:
• Describe the evidence base relating to the effect of nutrition on mental health
• Utilise a 'functional analysis' approach to help ascertain the relevance of nutrition for an individual client
• Recognise styles of cognitions that may alert the therapist to a potential nutritional involvement
• Utilise motivational interviewing and client self help material, to introduce and explore the relevance of nutritional issues with an individual client.

Teaching Methods: Initially a didactic presentation; followed by group discussion. Then pair work on written case material, followed by role play of client work. Final group discussion.

Nigel Mills is a Consultant Clinical Psychologist who works in Adult Mental Health and Health Psychology. He has a long standing interest in the effects of nutrition on mental health and has published single case studies in this area dating back to 1986. In a recent project for Primary Care, Nigel developed a format of nutritional assessment, a client education pack and client self ratings. This pack was used by cognitive therapists to help them identify and work with obvious nutritional issues. Nigel is the author of 'Holistic Formulation', published by Wiley.

Background readings:
1. Lane, J.D. et al. (1998) Caffeine raises blood pressure at work. Psychosomatic Medicine 60:327-330
2. Schmidt, M.H et al. (1997) Does diet influence conduct disordered children? - a controlled trial. European Child and Adolescent Psychiatry 6: 88-95
3. Gesch et al (2002) Influence of vitamins, minerals and fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo controlled trial. British Journal of Psychiatry 181, 22-28

 


Workshop 6

Expressive writing as a therapeutic method

James W. Pennebaker, The University of Texas at Austin, USA

When individuals write about emotional topics for as little as 15 minutes a day for three days, improvements in physical and mental health are seen. This workshop explores how and why expressive writing can have such power. Various writing methods will be discussed along with suggestions for their use in personal and therapeutic settings.

Who the workshop is aimed at: Very broad audience

The learning objectives:
• To learn the basic evidence supporting the power of writing
• To discuss the various methods of writing that have worked and those that have failed
• To explore the basic psychological, social, and cognitive mechanisms that can explain the writing effects
• To briefly try writing as a method of therapeutic gain

Teaching Methods: Lecture, experiential

James W. Pennebaker is Professor of Psychology at the University of Texas at Austin, where received his Ph.D. in 1977. He has been on the faculty at the University of Virginia, Southern Methodist University, and, since 1997, The University of Texas. He and his students are exploring the links between traumatic experiences and physical and mental health. His studies find that physician use, medical costs, and alcohol use can be reduced and work performance increased by simple writing and/or talking exercises. His most recent research focuses on the nature of language and emotion in the real world. Author or editor of 7 books and over 150 articles, Pennebaker has received numerous awards and honours.

Background readings:
1. Pennebaker, J.W. (1997). Opening Up: The Healing Power of Expressing Emotion. New York: Guilford Press.
2. Lepore, S., & Smyth, J. (2002). The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-Being. Washington, DC: American Psychological Association Press.
3. Petrie, K.J. & Weinman, J. (Eds) (1997). Perceptions of Health and Illness: Current Research and Applications. London: Harwood Academic Press.

 


Workshop 7

Cognitive Behavioural Treatment of Somatic Complaints in Children and Adults

Trudie Chalder, Guy's, Kings and St Thomas' School of Medicine and Anne Speckens, Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Trust

Who the workshop is aimed at: All health professionals, some experience of CBT helpful

The learning objectives:
• To present a general coherent model of understanding somatisation which takes into account individual experiences and differences
• To teach and practice specific cognitive and behavioural techniques for specific problems
• To discuss specific rationale's for different individuals
• To discuss difficulties regarding engagement.

Trudie Chalder is a cognitive behavioural psychotherapist. She has worked as a clinician and a researcher in the area of somatisation and medically unexplained symptoms for about 15 years.
Anne Speckens is a psychiatrist and also has several years worth of research and clinical experience working with somatising patients

Background readings:
1. Chalder T. (1999) Somatisation and inappropriate illness behaviour. in: Mental Health Nursing-An Evidence Based Approach. Edited by Rob Newell and Kevin Gournay. Churchill Livingstone. 13; 225-242.
2. Sharpe M, Chalder T. (1994) Management of the Chronic Fatigue Syndrome, in: Neurological Rehabilitation, 2nd Edition, L.S. Ellis, Editor, Blackwell Scientific Publications.
3. Speckens AEM, van Hemert AM, Spinhoven Ph, Hawton KE, Bolk JH, Rooijmans HGM. (1995) Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial. BMJ; 311: 1328-32

 


Workshop 8

Exposing fear of pain: Tackling avoidance in clinical setting

Zoë Clyde, Annie Moreland, Jannie Van der Merwe, and Rachel Vickers. INPUT Pain Management Unit, St Thomas' Hospital, London

Who the workshop is aimed at: This workshop is aimed at those who are interested in the application of CBT in a clinical setting.

We will explore the rapidly developing area of assessment and treatment of pain-related fears, which are powerful determinants of patients' behaviour. We aim to increase your understanding of fear and its effects on chronic pain. This will involve exploring the connection between fear, cognition and avoidance. The importance of cognitive processes such as catastrophising and the meaning of fear to individual patients will be discussed as will the conceptualisation of pain-related fears in relation to other anxiety disorders.

Assessment of pain-related fears is complex. For example, when a patient says, 'I physically can't get on the floor', the reason for this is not clear. Patients rarely present fear as the reason for stopping activity. It is hard for health professionals to identify whether avoidance of activity is due to a lack of practice and hence confidence in general, or due to a specific pain-related fear. We will introduce assessment tools that are currently in use in chronic pain management settings and discuss the practical implications of their use.

Evidence has shown CBT, which involves graded activity, is effective for chronic pain management (Morley et al.1999). Single case studies have shown graded exposure to be more effective than graded activity in addressing pain-related fears (Vlaeyen et al.2001). The danger of missing pain-related fears and using graded activity rather than graded exposure is that it can lead to the confirmation of the patient's worst fear and result in further avoidance undermining their success in applying pain management skills
We suggest that pain-related fear is not confined to chronic pain settings. It is hoped that discussion, drawing on participants' clinical experiences, can lead to the identification of other clinical settings where pain-related fear occurs and where the assessment and treatment methods highlighted can be used.

Learning Objectives:
• Introduction to the cognitive model of fear of movement and (re)injury and its implications for managing chronic pain
• The issues surrounding assessment of pain-related fears
• Discussion around the use of graded activity (GA), graded exposure (GE) and behavioural experiments.
• The wider application of these techniques to other clinical settings
• The importance of therapist beliefs

Teaching Methods: The format will be interactive, involving voluntary discussion of participants' own fears and those of the patients they work with. Group work and discussion will be used to explore case material.

The workshop leaders all work on a residential pain management programme at St Thomas' Hospital and have been involved in working with patients with pain-related fear.

Background Readings:
1. Crombez, G., Vlaeyen, J.W.S., Heuts, P.H.T.G., Lysens, R. (1999). Fear of pain is more disabling than pain itself. Evidence of the role of pain-related fear in chronic back pain disability. Pain, 80, 329-339.
2. Morley S.J., Eccleston C., Williams A. CdeC (1999). Systematic review and meta-analysis of randomised controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80, 1-13.
3. Vlaeyen J.W.S., Linton S.J. (1999). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85, 317-332.
4. Vlaeyen, J.W.S., De Jong, J., Geilen, M., Heuts, P.H.T.G., van Breukelen, G. (2001). Graded exposure in vivo in the treatment of pain-related fear: a replicated single-case experimental design in four patients with chronic low back pain. Behav. Res. Ther. 39, 151-166.

 


Workshop 9

Coping with Adversity: Cognitive Therapy in Adverse Life Situations.

Stirling Moorey, South London and Maudsley Trust

Who the workshop is aimed at: This workshop is aimed at health professionals who have some previous knowledge of cognitive behaviour therapy but would like to explore its application to patients facing adverse life circumstances. It will be particularly relevant to those working with chronic and life threatening illness, but will also be of use to anyone who has to help people deal with "realistic" negative thoughts. The methods covered are applicable to a range of situations including trauma, loss and physical disability.

The learning objectives:
• To use the cognitive model as a tool for conceptualising and planning treatment with this group of patients.
• To apply cognitive and behavioural techniques in 3 key areas:
a) Facilitating emotional processing.
b) Enhancing a sense of personal control to combat helplessness.
c) Dealing directly and indirectly with realistic negative automatic thoughts.
• To identify their own negative beliefs which interfere with their ability to work with patients facing real life difficulties.

Teaching Methods: Lecture, video, group discussions and role play. Participants will be expected to bring examples from their own clinical work.

Dr Moorey is Consultant Psychiatrist in Psychotherapy (CBT) at the Maudsley Hospital. He has been actively involved with cognitive therapy since 1979 and was co-founder of the Institute of Psychiatry Cognitive Therapy Course. From 1986-1991 he was a CRC research psychiatrist at the Royal Marsden Hospital, and worked with Dr Steven Greer to develop a cognitive based treatment for patients with cancer. The unit carried out two randomised controlled trials on the efficacy of this "adjuvant psychological therapy." He is author of the chapter "When Bad Things Happen to Rational People" in Frontiers of Cognitive Therapy and is co-author with Dr Steven Greer of "Cognitive Behaviour Therapy for People with Cancer" published by Oxford University Press in 2002. Dr Moorey regularly teaches on coping with adversity on the CBT courses at the Institute of Psychiatry, Newcastle, Salford and Dublin. The full one day version of this workshop has been given in Oxford and at University College London.

Background readings:
1. Moorey S & Greer S. (2002) Cognitive Behaviour Therapy for People with Cancer. Oxford University Press.
2. Moorey S (1996) When bad things happen to rational people: cognitive therapy in adverse life situations. In Salkovskis P(ed.) Frontiers of Cognitive Therapy. Guilford Press.
3. Snyder CR (Ed.) (1999) Coping: the psychology of what works. Oxford University Press.

 


Workshop 10

Setting up and delivering written and computer based self-help packages within a clinical service.

Christopher Williams and Graeme Whitfield, Division of Community-based Sciences, University of Glasgow.

Patients and health purchasers are demanding the provision of effective and accessible mental health treatments. Psychotherapeutic approaches are popular with patients, but access to specialist psychotherapy services is often limited. Other ways of offering treatment within the time and resources available to most practitioners need to be considered. One possible solution is the use of structured self-help materials that address common mental disorders. Self-help treatments are available in a variety of formats including delivery via books/workbooks and computers. Evidence exists for their effectiveness, however, a relatively neglected area has been a discussion of how to set up, deliver and monitor the use of such approaches within busy clinical services.

The learning objectives: The workshop will cover:
• What is self-help?
• The aims of self-help.
• Different ways of delivering self-help (different venues and different people).
• Supported versus unsupported self-help.
• How to select self-help materials for use with patients.
• Key steps in introducing self-help materials.
• Setting up a self-help room.
• Training staff in using self-help.
• Overcoming practical blocks to working in this way.
• Evaluating a clinical service using this approach.

The focus of the session will be on the use of the Overcoming Depression: Five Areas Approach self-help materials (both written and computer) however the content will also cover general principles of working in this way. The session will be relevant to both clinicians and managers who wish to start or develop clinical services that include self-help treatments.

Chris Williams is Senior Lecturer in Psychiatry and Honorary Consultant Psychiatrist at the University of Glasgow. His main clinical and research interest is in the area of Cognitive Behaviour Therapy (CBT) and in particular in looking at ways of disseminating this approach more widely. He has developed computer-based self-help treatments for depression and bulimia and is a well-known CBT trainer and teacher. HE is immediate Past-President of BABCP and is Chair of Glasgow Institute for Psychosocial Interventions (GIPSI) - which has a focus on training and research in evidence-based psychosocial interventions.

Graeme Whitfield is a Specialist Registrar in Psychiatry in Glasgow. He trained in CBT in Newcastle, and has an interest in self-help treatment deliveries. He was involved in setting up and evaluating a self-help room in a secondary care setting in Leeds, and is currently evaluating the CD Rom of Overcoming Depression: A Five Areas Approach. He has led the development and updating of BABCP's leaflets and is currently the BABCP representative and Governing Board member of UKCP.

Background readings:
1. Williams, C.J. (2001). Ready access to proven psychosocial interventions? The use of written CBT self-help materials to treat depression. Advances in Psychiatric Treatment 7:233-240
2. Whitfield, G., Williams, C.J. & Shapiro, D. (2001) An evaluation of a self-help room in a general adult psychiatry service. Behavioural and Cognitive Psychotherapy, 29(3):333-343
3. Keeley, H., Williams, C.J. & Shapiro, D. (2002) A United Kingdom survey of accredited Cognitive Behaviour Therapists' attitudes towards and use of structured self-help materials. Behavioural and Cognitive Psychotherapy, 30:191-201
4. Williams, C. (2002) Using structured Cognitive Behaviour Therapy self-help materials in a clinical service, Psychiatry, 1(3): 28-31
5. Whitfield, G. & Williams, C.J. (2003). The evidence base for CBT in depression: delivering CBT in busy clinical settings. Advances in Psychiatric Treatment, 9:21-30

 


Workshop 11

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 differentiating work with this client group from work with either psychosis or unipolar depression. 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.

Who 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 the key features of a cognitive behavioural approach including:
i) mood and activity monitoring
ii) identification of prodromes
iii) dealing with long term vulnerabilities

Teaching Methods: Lecture, video, case examples and discussion

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.

Background readings:
1. Jones, SH, Hayward, P & Lam, DH (2002). Coping with Bipolar Disorder. Oneworld
2. 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.
3. 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 12

Trauma and Psychosis: Cognitive Theory and Therapy

Anthony Morrison, University of Manchester, Douglas Turkington, Royal Victoria Infirmary, Newcastle-upon-Tyne, Warren Larkin & Pauline Callcott, Newcastle CB psychotherapy Centre

Abstract: This workshop will outline a cognitive approach to the understanding of the relationships between trauma and psychosis, in particular examining psychosis that is trauma-induced. The workshop will use a variety of techniques including teaching, examination of case studies, discussion, role play and video demonstration to illustrate how this model can be used to develop idiosyncratic case formulations with patients and how such formulations guide intervention. Specific issues including engaging patients, use of behavioural experiments, and identifying and challenging interpretations of voices, content of voices, delusional beliefs, schema change and PTSD-related strategies. The workshop will assume some knowledge of and basic skills in cognitive therapy.

Who the workshop is aimed at: Mental health professionals working with people with psychosis who have a basic level of knowledge and experience of cognitive therapy

Learning Objectives:
• To understand the relationships between trauma in psychosis
• To understand common factors in the development and maintenance of PTSD and psychosis
• To be able to assess trauma and trauma-related processes in people with psychosis
• To understand a cognitive model of trauma-induced psychosis
• To be able to generate formulations for people with psychosis that are inclusive of trauma
• To be able to assess and manage risk
• To be confident in using CBT techniques for PTSD and dissociation in psychosis
• To be able to work at the schema level with shattered assumptions and core beliefs

Teaching Methods: The workshop will use a variety of techniques including teaching, examination of case studies, discussion, role play and video demonstration.

The workshop leaders have extensive experience of cognitive therapy with people with trauma-induced psychosis, and collectively have published numerous papers and books on cognitive therapy and theory, PTSD and psychosis.

Background readings:
1. Kingdon, D. G. and Turkington, D. (1994). Cognitive-behavioural therapy of schizophrenia. Hove, Lawrence Erlbaum.
2. Morrison, A. P. (2001). The interpretation of intrusions in psychosis: An integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy 29: 257-276.

 


Workshop 13

Early Intervention in Psychosis: What kind of interventions and for whom?

Jo Smith, Worcestershire Mental Health Partnership NHS Trust

Who the workshop is aimed at: Qualified mental Health Practitioners, across disciplines, working in Early Intervention, Crisis Resolution, Assertive Outreach and Community Mental Health Teams.

The learning objectives:
• To understand the rationale and relevant research background underpinning Early Intervention service developments
• To consider specific issues when intervening early in the course of psychosis relating to individuals with psychosis, their families and early intervention service implementation
• To consider what kinds of interventions may be appropriate and for whom
• To consider the potential care pathways for individuals with psychosis and the role of early intervention developments in these pathways alongside community agencies, primary care and secondary care functional and community teams.

Teaching methods: Lecture/discussion and group exercises

Dr Jo Smith is a Consultant Clinical Psychologist and Worcestershire Early Intervention Lead, South Worcestershire Early Intervention Service.

Background readings:
1. Birchwood M, Fowler D and Jackson C (2000) (EDS) Early Intervention in Psychosis. A Guide to concepts, Evidence and Interventions. John Wiley and Sons Ltd. Chichester.
2. Edwards J and McGorry P.D. (2002) Implementing Early Intervention in psychosis. A guide to Establishing Early Psychosis Services. Martin Dunitz Ltd., London
3. IRIS (2000) Early Intervention Psychosis: Clinical Guidelines. Service Frameworks. IRIS/Rethink, Birmingham

 


Workshop 14

Unipolar and Bi-Polar Depression: similarities and differences

Jeny Bright and Ruth Williams, Institute of Psychiatry, London

Who the workshop is aimed at: Previous knowledge and experience of models and methods for the treatment of depression will be assumed. The workshop will be aimed at intermediate to advanced practitioners.

The learning objectives:
• To improve discrimination between problems, models and methods applicable to differing presentations of depression, including bi-polar patients
• To reflect upon and conceptualise problems in treating depression
• To practiceTo practise core skills

Teaching Methods: Will include some didactic presentation and demonstration but will aim to address participants problems and experiences and make use of experiential learning

Jeny Bright is well known and sought after for her expertise as a teacher, supervisor and talented therapist and clinician. She has a longstanding interest in depression and has published a study of group CBT in chronic depression. She was a member of the team at the IOP who recently developed and evaluated a relapse-prevention intervention for bi-polar patients.

Ruth Williams was a founder member of the team that starting teaching CBT at the IOP in 1987 and has been Programme Leader for the Diploma course and now the MSc that have succeeded it. Although having published empirical work in PTSD, she has always had a strong interest in depression, having co-edited a book, "Wounded Healers", a compilation of personal descriptions of depression experienced by mental health workers, which remained in print until 2002. She has also run a training clinic offering CT for depression for many years and most of her current case load is complex depression.

Background readings:
1. Lam, D.H., Jones, S.H., Hayward, P. & Bright, J.A. (1999) Cognitive Therapy for Bipolar Disorder: a therapist's guide to concepts, methods and practice. Chichester: Wiley.

 


Workshop 15

Transdiagnostic CBT for eating disorders

Christopher G Fairburn, University of Oxford

Who the workshop is aimed at: The workshop will be suitable for all those interested in CBT for eating disorders. Prior knowledge of CBT for eating disorders would be an advantage but is not essential.

The learning objectives:
• To understand the current status of cognitive behavioural models and treatments for eating disorders
• To understand the basis for proposing a transdiagnostic cognitive behavioural analysis of maintaining processes
• To be able to formulate patients' problems using this transdiagnostic conceptual framework
• To be able to design individualized cognitive behavioural treatments on this basis

Teaching Methods: The workshop will be interactive throughout. It will include didactic elements and the collective solving of clinical problems

Professor Christopher Fairburn is a leading international figure in the eating disorder field and Wwellcome Principal Research Fellow. He is one of the pioneers of CBT for eating disorders and has played a major role in research in the area.

Background readings:
1. Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: A "transdiagnostic" theory and treatment. Behaviour Research and Therapy (to be published in 2003).
2. Fairburn CG. Eating disorders. In: Clark DM & Fairburn CG (eds). Science and Practice of Cognitive Behaviour Therapy. Oxford: Oxford University Press, 1997.
Fairburn CG, Harrison PJ. Eating disorders. Lancet (to be published early in 2003).

 


Workshop 16

Exposure therapy to cognitive restructuring within/outside of reliving: A skills based workshop to build on basics in PTSD therapy

Deborah Lee and Kerry Young, Traumatic Stress Clinic, Camden & Islington Mental Health & Social Care NHS Trust and University College London

Who the workshop is aimed at: Clinicians with basic knowledge of CBT who wish to expand clinical skills

The learning objectives: Exposure therapy or reliving is regarded as an essential component of therapy for individuals with PTSD. It has an impressive evidence base and should form part of the treatment of choice. Yet in spite of its efficacy clinicians are often reluctant to undertake this approach for reasons such as 'retraumatising' the client, lack of confidence in their ability to carry out the procedure and fear that the approach is incongruent with the clients' goal to 'stop thinking and talking about the event'.

In this workshop we hope to abate some of these fears by exploring the ways in which clinicians can use exposure work in PTSD and by demonstrating/offering practice of this technique.

Secondly we will discuss and demonstrate the skills needed to cognitively challenge and restructure meaning in order to alleviate intrusive images. We will explore ways to decide on treatment approaches by using formulations to understand at what time in therapy the clinician should introduce exposure (i.e. as the only treatment, after schema focused cognitive therapy) and how and when to use cognitive restructuring (i.e. in the context of reliving, outside of reliving).

This workshop would be suitable to clinicians who work with individuals with PTSD and who would like the opportunity to revisit 'reliving' and practice their clinical skills in exposure work and cognitive restructuring. The workshop will involve 'in vivo' demonstrations of therapy techniques and practice for participants.

By the end of the day clinicians should feel confident to use these techniques in cases of PTSD regardless of the complexity of presentation.

Teaching Methods: lecture, video, experiential

Deborah Lee is a Consultant Clinical Psychologist who has specialized in the field of PTSD for the past 11 years. She coordinates the Adult traumaticTraumatic Stress Service, which is part of the Traumatic Stress Clinic in London. She has extensive clinical experience in assessment/treatment of trauma and complex PTSD cases and has given many workshops and lectures on this topic.

Kerry Young, a clinical psychologist at the Traumatic Stress Clinic in London, has specialised in the assessment and treatment of traumatic stress for six years. She has amassed extensive clinical experience during this time and has conducted many workshops on this topic and on treating PTSD in refugees.


Background readings:
1. Grey, N., Young, K. and Holmes, E. (2002) Cognitive restructuring within reliving: a treatment for emotional 'hotspots' in Posttraumatic Stress Disorder. Behavioural and Cognitive Psychotherapy, 30, 37-56.
2. Lee, D.A., Scragg, P. & Turner, S.W. (2001). The role of shame and guilt in reactions to traumatic events: A clinical formulation of shame-based and guilt-based PTSD. British Journal of Medical Psychology, 74, 451-466
3. Marks, I, Lovell, K, Noshirvani, H, Livanou, M & Thrasher, S (1998). Treatment of Post-Traumatic Stress Disorder by exposure and/or cognitive restructuring: A controlled study. Archives of Psychiatry, 55 317-325
4. Shalev, A.Y., Bonne, O & Eth. S. (1996). Treatment of Posttraumatic Stress Disorder: A Review. Psychosomatic Medicine, 58, 165-182

 


Workshop 17

Basics of behavioural activation treatment for depressed adults.

Christopher R. Martell, University of Washington, USA

Behavioural activation (BA) is a positive approach to treating depression. Working within this framework the therapist helps clients to see depression not as something inside of them but as a natural consequence of the way they cope with the shifting contexts of daily life. There is no search for mental illness, skill deficits, or distortions in thinking. Rather, the therapist coaches the client to engage in activities that will lead to a more rewarding life. BA attempts to help depressed people re-engage in their lives through focused activation strategies. These strategies counter patterns of avoidance, withdrawal, and inactivity that may exacerbate depressive episodes. BA is designed to help patients approach and access sources of positive reinforcement in their lives, which can serve a natural antidepressant function. BA as it is currently practiced has been developed to maximize the potential of a functional analytic treatment, which is epistemologically rooted in the philosophy of contextualism and a behavioural theory of depression.

Randomised controlled trials of depression have shown no difference in outcome between BA and cognitive therapy. Although the current research on behavioural activation will be reviewed, the workshop has been developed to help practicing clinicians to learn new skills and to add to current cognitive-behavioural proficiency.

Who the workshop is aimed at: This workshop is intended for an audience that has an understanding of basic behavioural and cognitive behavioural principles. It is appropriate for beginners and intermediate level clinicians who wish to learn about recent evidence-based advances in the treatment of depression.

The learning objectives:
• Understand the principles of treating depression from a contextual perspective.
• Conceptualise cases from a behavioural perspective and formulate an activation treatment plan.
• Target avoidance behaviours and teach clients to implement action.

Teaching Methods: The workshop will consist of lecture, video presentations and role-play exercises.

Christopher R. Martell is Clinical Associate Professor of Psychology at the University of Washington and also works in independent practice. He received his Ph.D. in clinical and school psychology in 1988 from Hofstra University in New York. He is board certified in both clinical psychology and behavioural psychology through the American Board of Professional Psychology. Dr. Martell has worked as a research therapist on three psychotherapy outcome studies funded by the National Institute of Mental Health. He is co-author (with Neil S. Jacobson and Michael E. Addis) of Depression in Context: Strategies for Guided Action, published by W.W. Norton.

Background readings:
1. Martell, C.R., Addis, M. E., & Jacobson, N.S., (2001). Depression in Context: Strategies for Guided Action. London: W. W. Norton & Company, Inc.
2. Ferster, C. B. (1973). A functional analysis of depression. American Psychologist, 28, 857-870.
3. Jacobson, N.S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation therapy for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8 (3), 255-270.

 


Workshop 18

Exposure Across Anxiety Disorders: Overcoming Resistance and Refining Approaches.

Christine Purdon, University of Waterloo, Ontario, Canada

Exposure-based interventions for anxiety problems can be extremely effective. However, developing and sustaining the client's motivation to engage in exposure exercises, especially outside the office, can be challenging. Failure to complete exposure work can lead to a breakdown in the therapeutic relationship and in premature termination of treatment. At the same time, the therapist is faced with many decisions about how precisely to set up an exposure session. For example, should the therapist engage in cognitive restructuring during exposure? When is imaginal exposure useful? Is distraction a hindrance? The purpose of this workshop is to present strategies for enhancing and sustaining motivation to engage in exposure and to help refine therapists' approach to exposure across anxiety disorders. The workshop will review the theoretical model of exposure then discuss ways of refining exposure exercises to maximize results when treating panic disorder, social anxiety and OCD. Following this, the workshop will focus on "resistance" to exposure, examining factors often responsible for resistance and ways of overcoming it, again within panic disorder, social anxiety and OCD. Especial attention will be paid to overcoming resistance in OCD as rituals can often be extremely difficult for clients to give up, and different sub-types of OCD are often associated with different kinds of motivational problems. The workshop will make heavy use of case examples from the presenter's clinical experiences, as well as videos. Attendees will also be invited to speak about cases they have struggled with throughout the workshop so that the presenter and audience can brainstorm solutions.

The learning objectives:
To help therapists refine their approach to exposure-based interventions for anxiety problems and develop some strategies for overcoming resistance to exposure.

Teaching Methods:
The workshop will be didactic.The workshop will be didactic, with the use of video, case examples and examples offered by the audience. Detailed handouts will be provided.

Dr. Christine Purdon has studied anxiety disorders and OCD for the past 12 years, researching cognitive and behavioural factors in the development and persistence of the disorder. She has earned three early career awards for her contribution to research in OCD and anxiety disorders. Dr. Purdon is a Certified Psychologist and a member of the Academy of Cognitive Therapy. She is actively involved in the assessment and treatment of OCDanxiety disorders through the Anxiety Treatment and Research Centre at St. Joseph's Hospital in Hamilton, Ontario, and participated in the development ofthe treatment protocol for OCDprotocols used there. She is also co-authoring a book on the treatment of OCD with Dr. Laura Summerfeldt and Dr. Martin Antony under contract with the American Psychological Association.

Background reading:
1. Antony, M.M. & Swinson, R.P. (2000). Phobic disorders and panic in adults: A guide to assessment and treatment. Washington: American Psychological Association
2. Antony, M.M. & Swinson, R.P. (2000). The shyness and social anxiety workbook. Oakland New Harbinger
3. Barlow, D.H. (2002). Anxiety and its Disorders. New York Guilford.


Workshop 19

The paradox of thought control: Cognitive therapy for obsessive-compulsive disorder

Maureen L. Whittal, Anxiety Disorders Unit, UBC Hospital, Canada

Recent theoretical advances in the cognitive treatment (CT) of OCD appear promising and may improve the outcomes of exposure-based treatments, which can be difficult to tolerate. Moreover, CT may be particularly useful in treating people with primary obsessions, who have traditionally achieved less success with exposure and response prevention. The purpose of this workshop is to introduce participants who are familiar with exposure and response prevention to cognitive treatment and assessment for OCD. The importance of identifying interpretations of intrusive thoughts will be emphasized but the bulk of the workshop will focus on cognitive strategies to challenge these interpretations. Common pitfalls in providing this treatment will also be addressed.

Who the workshop is aimed at: Practitioners who are familiar with CT/CBT and have a moderate amount of experience in treating OCD.

The learning objectives:
• The cognitive model of OCD and its implications for treatment
• The belief domains thought to be relevant in OCD
• How to successfully challenge a patient's cognitive interpretations without trying to talk them out of their obsessions

Teaching Methods: Mainly lecture and some experiential and some role play.

Maureen Whittal, Ph.D. is the manager of the Anxiety Disorders Unit at UBC Hospital in Vancouver, British Columbia, Canada and is a member of the Obsessive Compulsive Cognitions Working Group (OCCWG). The OCCWG is a unique worldwide collaboration of researchers interested in the cognitive assessment and treatment of OCD. She has worked in the area of OCD since 1996 (and since 1986 in the anxiety disorders) and conducted a recent large- scale trial of CT for OCD.

Background readings:
1. Obsessive-compulsive cognitions working group (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667-682.
2. Salkovskis, P.M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, S29-S52.
3. Whittal, M.L., Rachman, S. & McLean, P.D. (2002). Psychosocial treatments for OCD: Combining cognitive and behavioural treatments. In G. Simos (Ed.). Cognitive Behaviour Therapy: A guide for the practising clinician. (pp. 125-149).


Workshop 20

Mindfulness-based Cognitive Therapy for Depression: a new approach to preventing relapse

Mark Williams, University Department of Psychiatry, Warneford Hospital Oxford

Recent data suggests that depression is set to become one of the Western world's largest burdens of ill-health over the next twenty years. Much of this high rate of depression is due to the high risk of relapse and recurrence in those who have been depressed before. Recurrence occurs when small shifts in negative mood retrigger old habits of negative thinking formed during precious episodes.

Mindfulness-based cognitive therapy (MBCT) combines Jon Kabat Zinn's Stress Reduction program with techniques from Cognitive Therapy in an eight week 'class' format for up to twelve patients who are currently in remission. It aims to teach participants how to become aware of early warning signs of relapse, and to reduce tendencies to avoid these early signs. It includes breathing meditation and yoga stretches to help participants become more aware of moment-to-moment changes in the mind and the body. It also includes basic education about depression, and exercises from cognitive therapy that emphasise the links between thinking and feeling.

Who the workshop is aimed at: This is an Introductory workshop for health professionals, especially those who deal with recurrent depression in their patients. Some previous experience with CBT for depression is highly desirable, but it may also be of interest to those who have applied meditation-based approaches in healthcare settings.

The learning objectives:
By the end of the workshop, participants will know:
• the recent evidence on the nature of cognitive risk for relapse
• why a mindfulness-based approach may be an appropriate way to address such risk
• the preliminary evidence on efficacy
And will have experienced:
• some of the MBCT practices used in the 8-week programme
• how these are integrated with CBT through dialogue and discussion of the practice

Teaching Methods: Lecture and dialogue, video, experience of practices used in MBCT

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.

Background readings:
1. Kabat-Zinn, J.(1990) Full catastrophe living. New York:
2. 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.
3. Teasdale, J.D., Segal, Z.V., Williams, J.M.G., Ridgeway, V., Lau, M., & Soulsby, J. (2000) Reducing risk of recurrence of major depression using Mindfulness-based Cognitive Therapy. Journal of Consulting and Clinical Psychology, 68, 615-23