DETAILS OF EACH WORKSHOP ARE GIVEN BELOW:
Simple or Elegant?: What are the Creative Ways Clinicians Adapt Cognitive Behaviour Therapy for Working with People with Intellectual Disabilities?
Jamie Kirkland, NHS Lothian, UK & Keith Marshall, NHS Lothian, UK
There is a variety of clinicians working with people with intellectual abilities (ID) who utilise a CBT framework (for example see Special Issue JARID (19), 2006). The presenters feel that published research often neglects to mention adaptations needed in the CBT approach. Indeed, Whitehouse (2006), looking at studies that mentioned adaptations, found that whilst a variety were listed in the literature, many studies did not clearly describe adaptations to the therapeutic process or comment on how far these changes constituted departures from the underlying model, making replication difficult. An example of published work in adapting the CBT framework for people with ID has been completed by Kirkland (2005). In this three case studies showed how using pictorial aids helped in the sharing of the formulation. A further case study presentation by Willner & Goody (2006) consider the adaptations needed to be made in relation to the consideration of cognitive deficits versus cognitive distortions. However the presenters are mindful of an unpublished survey (Eliot, 2002) that reported many clinicians found simplifying CBT difficult. Indeed there is an anecdotal feeling that the clinician can often feel that creative approaches leave true CBT behind.
Key Learning Objectives:
This workshop is designed to:
Dr. Jamie Kirkland is a Chartered Clinical Psychologist who works in a community learning disabilities service. He utilises both CBT and CAT approaches in his work and his particular interest is in developing a better understanding of how formulations are shared with clients. Keith Marshall, is a BABCP accredited Cognitive Behaviour Therapist working in inpatient and outpatient learning disability services. His current interested are in systematic and family applications of CBT.
Kirkland, J .(2005). Cognitive behaviour formulation for three men with learning disabilities who experience psychosis: how do we make it make sense? British Journal of Learning Disabilties, 33, 160-165
Whitehouse, Tudway, Lock & Stenfert-Kroese (2006). Adapting individual psychotherapy for adults with intellectual abilities. Journal of Applied Research in Intellectual Disabilities, 19.
Willner, P. & Goody, (2006). Interactions of cognitive distortions and cognitive deficits. Journal of Applied Research in Intellectual Abilities, 19.
Understanding and Treating Disturbed Body Image in the Eating Disorders: A Cognitive-Behavioural Approach
Vicki Mountford, St. George’s Eating Disorder Service & St. George’s, University of London, UK and
Body image disturbance can be one of the most resistant aspects of an eating disorder and may manifest long after behaviours have ceased. In our clinical experience, many patients struggle with this aspect of their disorder and therefore, it may contribute to relapse. However, surprisingly little empirical evidence regarding the treatment of body image exists. Indications of what to do, for which patient, and at what stage of treatment, are limited. This workshop will focus on the use of cognitive-behavioural therapy (CBT) principles to understand, collaboratively formulate and develop interventions for disturbed body image with their patients. Significant elements of this approach include understanding the contribution of early experiences, exploring the emotional meaning associated with body image, addressing underlying beliefs and modifying behaviour. Participants will be invited to explore their own attitudes towards body image and the impact this may have on their work. Treatment approaches include developing a narrative of their body image, psychoeducation, video work and imagery, as well as more traditional CBT techniques. Participants will need a basic understanding of CBT.
Key Learning Objectives:
At the completion of this presentation, participants will be able to:
1.Explore their own attitudes towards body image and the impact this may have on their work.
2.Formulate the contribution of early experiences, cognitions and emotional meaning to disturbed body image and identify maintaining factors.
3.Understand the construct of body image and be able to develop a rationale and framework for treatment with the patient.
4.Utilise skills in modifying disturbed body image within a CBT framework
Dr Victoria Mountford is Principal Clinical Psychologist at St. George’s Eating Disorder Service, London, Dr Emma Corstorphine is Consultant Clinical Psychologist at the Oxford and Buckinghamshire Eating Disorders Service. Both work with in, day and out-patients. They have published on both clinical and research aspects, including a recent Treatment Guide, and have presented at a number of international conferences.
Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V., & Russell, K. (2007). Cognitive-behavioural therapy for the eating disorders: A comprehensive treatment guide. Cambridge, UK: Cambridge University Press.
Key, A, George, CL, Beattie D, Stammers, K, Lacey, H & Waller G. (2002) Body image treatment within an inpatient program for anorexia nervosa: the role of mirror exposure in the desensitization process. International Journal of Eating Disorders, 31, 185-90.
Mountford, V., Haase, A., & Waller, G. (2006). Body checking in the eating disorders: Association between cognitions and behaviours. International Journal of Eating Disorders, 39, 708-15.
Workshop 3Delivery IAPT- A Practical Approach to Delivering IAPT in your Team
Chris Williams, University of Glasgow, UK
A significant investment is occurring throughout the UK in new ways of working. IAPT in England and NHS Living Life in Scotland offer the prospect of significantly increasing access to CBT by introducing low intensity working alongside higher intensity work. However delivering this work is easier to describe in written documents than in reality.
Key Learning Objectives:
Dr Chris Williams is a senior lecturer in Psychological Medicine at the University of Glasgow and Honorary Consultant in NHS Greater Glasgow and Clyde. He is a past President of BABCP and has extensive experience in introducing low intensity interventions into teams across the UK and elsewhere. The START team managed by Dr Williams won a team of the year award in 2006. Extensive training on the SPIRIT course of >500 practitioners and work with over 30 clinical teams in Glasgow and across the UK has led to extensive experience of the issues involved in introducing such services.
Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S. & Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, 11, 1-24.
Core Competencies for Working with Substance Misuse and Addictive Behaviour
Frank Ryan, Central & North West London Foundation NHS Trust & Birkbeck College, University of London, UK
There is now emerging consensus on the optimal engagement and cognitive behavioural modification strategies needed to address substance misuse and addiction. In the United Kingdom, guidelines have been produced by the National Institute for Health and Clinical Excellence (NICE) evaluating psychosocial interventions and drug dependence. Combined with other research findings, it is now possible to specify the core competencies needed to generate better outcomes. Their utility can only be exploited if they are more widely deployed.
Key Learning Objectives:
The session will primarily aim to demonstrate core competencies and encourage participants to explore, adapt and practice these skills. The format of the Workshop will include a briefing on recent developments in treating addictive disorders with particular reference to cognitive behaviour therapy and motivational enhancement approaches. Participants will then be introduced to the core competencies essential for working effectively with the spectrum of substance misuse disorders. These include brief or low intensity interventions such as motivational enhancement, guided self-help and contingency management techniques. Generic cognitive behavioural competencies such as conceptualisation and formulation will also be demonstrated in the substance misuse context, with particular reference to working with co-morbid disorders.
Frank Ryan is a consultant clinical psychologist who has worked as a cognitive behaviour therapist in the addiction field for many years. He is active in research and is an Honorary Research Fellow at Birkbeck College, University of London. He is an experienced workshop facilitator, trainer, clinical supervisor and former Chair of the British Psychological Society's Faculty of Addiction.
National Institute for Health and Clinical Excellence (2007) Drug misuse: Psychosocial Interventions and Opiod Detoxification. (http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11812)
Ryan, F. (2006) Appetite lost and found: Cognitive psychology in the addiction clinic. In Cognition and Addiction. Munafo, M. & Albery, I. (Eds). Oxford University Press.
CBT with Older People: A Psychogerontological Approach
The world is experiencing a profound and irreversible demographic shift impacting upon the structure of societies so that psychotherapists are much more likely to come into contact with older people and yet therapists may feel ill-prepared to meet the needs of a ‘greying society’. Knight (2004) notes that therapists unused to working with older people often believe older people are unlikely to benefit from psychotherapy and yet Squalls et al., (2002) in a survey of practitioner members of the American Psychological Association showed that therapists who worked with older people were more likely to want to increase their hours working with this population thus perhaps dispelling the myth that working with older people is depressing and de-motivating. Depression in later life is often thought of as being a ‘natural’ reaction to the challenges and deficits that ageing brings in its wake and this can result in therapeutic nihilism as therapy becomes less focussed, more passive and consequently less effective. Therapists faced with a growing client base of people in their eighth, ninth and tenth decades may experience uncertainty about the adequacy of standard psychological treatments and models. For these reasons there is the need for psychotherapists to update themselves of developments in gerontology and geriatrics so as to ensure that the needs of older clients are likely to be met. CBT is particularly appropriate as an intervention for older adults because it is skills enhancing, present-oriented, problem-focussed, straightforward to use and effective. While CBT for late life depression in later life is the most systematically researched psychological treatment approach for use with older people, much less emphasis has been placed on understanding process issues in working with older people. This workshop will address process issues and consider contextual factors such as dealing with expectancies about lifespan, the likelihood of chronic physical illness and longevity and chronicity of the personal history of problems. An age appropriate lifespan developmental comprehensive conceptualisation of CBT with older people is also presented in this workshop. Audio-visual clips of case vignettes are used to confront challenges of using CBT with older people and through active participation by attendees, practical and helpful solutions are developed and discussed.
Key Learning Objectives:
By the end of this workshop participants should:
Dr. Ken Laidlaw, PhD is a Senior Lecturer and Professional Lead for Older Adults Clinical Psychology services in Edinburgh. With Professors Larry Thompson and Dolores Gallagher-Thompson, he is the principal author of the only non-edited book on CBT with older people (Laidlaw et al., 2003) and with Professor Bob Knight he is co-editor of The Handbook of Emotional Disorders in Later Life (OUP, 2008). The principal investigator in the first UK systematic evaluation of individual CBT for late life depression (Laidlaw, et al., 2008) he has also published a number of articles and book chapters on CBT with older people.
Laidlaw, K. Thompson, L. W., Dick-Siskin, L. & Gallagher-Thompson, D. (2003) Cognitive Behaviour Therapy with Older People. Chichester; John Wiley & Sons Ltd.
Laidlaw, K. Thompson, L.W., & Gallagher-Thompson, D. (2004) Comprehensive conceptualization of cognitive behaviour therapy for late life depression. Behavioural and Cognitive Psychotherapy, 32: 389-399 3.
Knight, B. G. (2004) Psychotherapy with Older Adults, 3rd Edition. Thousand Oaks: Sage Publications
Workshop 6Acceptance and Commitment Therapy for Psychosis
Eric Morris, South London & Maudsley NHS Foundation Trust & Institute of Psychiatry, King's College London, UK; Gordon Mitchell, NHS Fife, Scotland, UK & Amy Hodgson, NHS Fife, Scotland, UK
Acceptance and Commitment Therapy (ACT) is a contextual CBT that uses mindfulness and values-based behavioural activation strategies to help people develop a workable relationship with internal experiences as part of a direction of increasing life meaning and vitality. ACT involves an experiential approach to therapy, based upon empirical principles of behaviour change. Clients are guided through exercises and metaphors to develop a present moment focus, clarify personal values and explore the functional utility of coping strategies. There has been promising evidence to suggest ACT can help people who are distressed and/or disabled by psychosis to learn a mindful and accepting stance toward unusual experiences, reducing the impact of symptoms, and improving social functioning (Bach & Hayes 2002; Gaudiano & Herbert, 2006). This workshop will present an ACT approach to psychosis, including how the problems of psychosis are conceptualised in this model and modifications to mindfulness and acceptance techniques for this population.
Key Learning Objectives:
This workshop is designed for clinicians who work with people experiencing psychosis. The workshop is designed to:
Eric Morris works as a consultant clinical psychologist for the Lambeth Early Onset Service, an inner-city early intervention service for psychosis based in south London. He is currently conducting research in acceptance and mindfulness interventions for psychosis at the Institute of Psychiatry, King’s College London. Gordon Mitchell and Amy Hodgson are clinical psychologists in NHS Fife, Scotland, working with clients who experience severe and enduring mental illness. Over the past four years they have been increasingly using ACT approaches with this client group, particularly in-group formats.
Bach, P. (2004). ACT with the seriously mentally ill. In S.C. Hayes & K.D. Strosahl (Eds). A practical guide to acceptance and commitment Therapy. Springer: New York.
Bach, P., & Hayes, S.C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139.
Gaudiano, B.A., & Herbert, J.D. (2006). Acute treatment of inpatients with psychotic symptoms using acceptance and commitment therapy: Pilot results. Behaviour Research and Therapy, 44, 415-437.
Workshop 7Substance Use Amongst People with Mental Health Problems
Hermine Graham, University of Birmingham and Birmingham & Solihull Mental Health (NHS) Trust, UK; Derek Tobin, Birmingham & Solihull Mental Health (NHS) Trust & University of Birmingham, UK &
Emma Griffith, Birmingham & Solihull Mental Health (NHS) Trust & University of Birmingham, UK
Alcohol and drug use is very common amongst people with mental health problems and can often be a maintaining factor for emotional disorders or psychosis. Cognitive interventions for these problems do not typically address the role of alcohol and drugs. Cognitive-Behavioural Integrated Treatment (C-BIT) is a structured but flexible integrated psychosocial treatment approach designed specifically for working with clients with severe mental health problems who are using substances problematically (Graham et al., 2003; Graham et al.,2004). It is based on the established principles and techniques of cognitive therapy for emotional disorders (Beck, 1976), substance misuse (Beck et al., 1993) and psychosis (e.g., Fowler et al., 1995; Kingdon & Turkington, 1994). The underlying philosophy is one of integrated mental health and substance misuse treatment (Mueser et al., 2003). It seeks to develop a formulation that addresses both the mental health and substance use, build motivation to change and to target key cognitions that maintain a vicious cycle of substance misuse and mental health problems. The aim of the workshop is to introduce participants to a cognitive therapy approach for alcohol and drug use in people with mental health problems.
Key Learning Objectives:
Participants will acquire the following skills:
Dr Hermine L. Graham is a Consultant Clinical Psychologist in Birmingham and Solihull Mental Health (NHS) Trust and a Lecturer in the School of Psychology, University of Birmingham. She previously worked as Head of the Combined Psychosis and Substance Use (COMPASS) Programme in Birmingham, developing and evaluating an integrated treatment approach for people with severe mental health problems who use alcohol/drugs problematically. Her clinical and research interests include cognitive understandings of the relationship between problematic substance use and psychosis and the application of Cognitive Therapy to this client group. She has co-edited the book Substance Misuse in Psychosis: approaches to treatment and service delivery (2003) and written the treatment manual Cognitive-Behavioural Integrated Treatment (2004). Derek Tobin is a Clinical Nurse Specialist and team manager of the COMPASS Programme in Birmingham & Solihull Mental Health (NHS) Trust. He played an active part in the research and evaluation of Cognitive Behavioural Integrated treatment (C-BIT) within local assertive outreach teams. He provides training and support to clinicians within Assertive Outreach and Early intervention services in the delivery of C-BIT. He is currently overseeing the delivery of an integrated therapy approach within a forensic setting. Dr Emma Griffith is a Clinical Psychologist in Birmingham and Solihull Mental Health (NHS) Trust at the COMPASS Programme. She works clinically with an Assertive Outreach Team one day a week to support the use of C-BIT as an integrated treatment approach for substance use and severe mental health problems and as part of an assessment and brief intervention service. She is currently involved in coordinating a number of research projects at the COMPASS Programme; including service users, carers and staff perspectives on substance use and severe mental health problems and it’s treatment within teams trained to use the C-BIT approach.
Baker, A. and Velleman, R. (Eds). (2007). Clinical Handbook of Co-existing Mental Health and Drug and Alcohol Problems. London, UK: Routledge.
Graham, H. L., Copello, A., Birchwood, M., Mueser, K, T., Orford, J., McGovern, D., Atkinson, E., Maslin, J., Preece, M., Tobin, D. and Georgiou, G. (2004). Cognitive- Behavioural Integrated Treatment (C-BIT). A Treatment Manual for Substance Misuse in People with Severe Mental Health Problems. Chichester, UK: John Wiley & Sons Ltd.
Graham, H. L., Copello, A., Birchwood, M. and Mueser, K, T. (Eds). (2004). Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery. Chichester, UK: John Wiley & Sons Ltd.
The Method of Levels: Bringing About Change by Shifting Awareness
Warren Mansell and Sara Tai, School of Psychological Sciences, University of Manchester, UK
Increasing a client's awareness of their problem(s) is either implicitly or explicitly indicated in many cognitive behavioural therapies. Through completion of activities such as thought diaries, clients may become more aware of the mechanisms underlying their identified problems; subsequently enabling them to identifyimportant areas to target with a clearer view on what can lead to change and ultimately, improvement. Later developments such as schema focussed work, and guided discovery also utilise the mobility of awareness and perceived control to access different aspects of a client's consciousness. Third wave cognitive behaviour therapies such as Acceptance and Commitment Therapy and Metacognitive Therapy address awareness and control directly. Perceptual Control Theory (PCT) provides a theoretical explanation for the importance of control by explaining a proposed link between awareness and a process of change called ‘reorganisation’. The Method of Levels (MOL) is a cognitive technique based on PCT that specifically aims to direct a client’s attention to higher cognitive levels, enabling them to become more aware of the nature of their difficulties. From this point of view a problem solving perspective is pursued, largely through a metacognitive process,and the client is assisted in generating solutions and gaining control over their distress. As a way of helping clients focus on process rather than content, MOL can be used to enhance the effectiveness of treatments for specific problems and disorders and also to address issues in the delivery of treatment such as lack of engagement, poor motivation, and resistance. This workshop is designed as an introduction to the Method of Levels in line with Tim Carey’s previous half-day workshop at the 2006 BABCP conference Warwick and his full-day pre-congress workshop at the 2007 BABCP conference in Brighton. Both workshops were received positively as indicated by the feedback ratings of participants
Key Learning Objectives:
By the end of the workshop the participants will have had opportunities to: Understand the role of perceived control in symptom reduction. Identify the role of control in their current practices. Explore the implications of incorporating more control activities in their current practices. Participate in activities specifically aimed at developing perceived control and awareness. Experience shifting awareness of others and increasing perceived control through role-play. Clarify the nature of control, how it can be disrupted, and how it might be restored.
Warren Mansell is a clinical psychologist and lecturer at the University of Manchester. He has authored over 40 publications on the science and practice of CBT, including work on social phobia, bipolar disorder and the transdiagnostic approach. Sara Tai is also a lecturer at the University of Manchester and a senior clinical psychologist within Greater Manchester West Mental Health NHS Trust. She has published research within the field of bipolar disorders and psychotic symptoms and is an experienced practitioner of CBT, including MOL, for people with complex problems.
Carey, T. A. (2006). The Method of Levels: How to do psychotherapy without getting in the way. Hayward, CA: Living Control Systems.
Carey, T. A. & Mullan, R. J. (2007). Patients in Charge: A naturalistic investigation of a patient led approach to treatment in primary care. Counselling Psychology Quarterly, 20(1), 1-14.
Carey, T. A. (in press). Perceptual Control Theory and Method of Levels: Further contributions to a transdiagnostic perspective. International Journal of Cognitive Therapy.
Mansell, W. (2005). Control theory and psychopathology: An integrative approach. Psychology and Psychotherapy: Theory, Research and Practice, 78, 141-178.
Positive Psychological Interventions
There has been an increased interest in understanding the psychology of positive emotions and well being. The literature in this area spans from international studies on happiness (Diener, Oishi & Lucas 2005), well being in organisations (Linley & Joseph 2004) to clinical trials particularly in the area of affective disorders (Seligman 2005). Positive psychological interventions can add to the therapeutic armamentarium of cognitive behavioural therapists but require an understanding of the background empirical research, formulation and familiarity with techniques. Such a therapist specific synthesis is not widely available in literature or in therapy training courses. It is also important to critically discuss the appropriate use of positive psychological interventions.
Key Learning Objectives:
This workshop is designed to provide
Sanjay Kumar Rao is a Consultant Liaison Psychiatrist and Head of The Logos Centre for CBT and Mental Health Promotion in the TEWV NHS Trust. He is involved in developing CBT services and developing training programmes for mental and physical health professional. He has also delivers national presentations and workshops in positive psychological interventions Kirstine Postma is a Consultant Clinical Psychologist in the Easington Mental Health Services of the TEWV NHS Trust. She is involved in teaching and supervision of mental health staff in CBT. Her interests are in positive psychological and strength based approaches in CBT practice
Carr, A. Positive Psychology. (2003) The Science of Happiness and Human Strengths. Brunner-Routledge: New York
Duckworth A.L, Sheen, T, Seligman M.E.P. (2005). Positive Psychology in Clinical Practice. Ann Rev of Clin Psychology 1:629-51
Linley, A, Joseph, S. (2004) Positive Psychology in Practice. John Wiley & Son Inc: New Jersey
Using Experiential Techniques to Facilitate Cognitive Change in Complex Cases of PTSD
Ann Hackmann, University of Oxford & Institute of Psychiatry, King’s College London, UK
The presenter works in the research group that developed the Ehlers and Clark (2000) model of PTSD, used in three treatment trials, with good results. The treatment involves elements of in-vivo and imaginal exposure, and cognitive strategies to target distorted meanings. These elements are carefully interwoven in ways that facilitate cognitive change even in complex cases. The goal of the workshop is to show how experiential learning facilitates emotional processing, and how it is applied to aspects of treatment in straightforward or more complex cases of PTSD:- Identification of ‘hot-spots’ in the trauma memory Examination of meanings and distortions Verbal updating of hotspots during reliving Imaginal techniques to enhance shifts in beliefs and affect Examination of trauma memories for input from earlier traumas Earlier memories transformed using imagery rescripting Metaphorical imagery and transformations for overwhelming memories Examination of schizotypal and other meta-cognitive beliefs Behavioural experiments to challenge them Discrimination between what happened then, and what is happening now Nightmares addressed using imagery rehearsal Suicidal imagery examined and transformed This workshop draws on the work of the Ehlers and Clark group, and techniques developed by Brewin, Foa, Arntz, Young, Holmes and Krakow, and many others.
Key Learning Objectives:
Participants will learn how to:
Ann Hackmann (clinical psychologist) works as a researcher and practitioner in a research group led by Anke Ehlers and David Clark. This group has conducted three PTSD treatment trials, and many other studies of anxiety disorders. One of her major interests is in experiential techniques, including imagery rescripting and behavioural experiments.
Hackmann, A. (2004). Compassionate Imagery in the Treatment of Early Memories in Axis I Anxiety Disorders. In: P. Gilbert (ed). Compassion: Conceptualisations, Research and Use in Psychotherapy. London, Brunner-Routledge.
Grey, N., Young, K., Holmes, E. (2002) Cognitive Restructuring within Reliving: A treatment for peritraumatic emotional hotspots in post-traumatic stress disorder. Behavioural and Cognitive Psychotherapy, 30, 37-56
Krakow B & Zadra A (2006) Clinical management of chronic nightmares: Imagery rehearsal therapy. Behavioural Sleep Medicine, 4 no 1 pp 45-70
CBT Training and Supervision:What Should We Be Training and How Should We Be Doing It?
James Bennett-Levy, University Dept of Rural Health (Lismore), Sydney University, Australia
Over the next years, thousands of new therapists will be trained in CBT, a therapy which boasts a strong conceptual basis. Remarkably, these thousands will be recipients of training strategies with little empirical support or theoretical base. Both are required, otherwise there is a risk that a lot of money and resource will needlessly go down the drain. This workshop will present a model of therapist skill development which has evolved over a number of years (Bennett-Levy et al., 2001; Bennett-Levy, 2006; Bennett-Levy & Thwaites, 2007; Thwaites & Bennett-Levy, 2007). Empirical data supportive of the model will be briefly reviewed. In the workshop we ask: How can we best conceptualise the CBT understandings and skills which we need to develop in trainees and ourselves? How do these skills relate to one another? What methods of training/supervision are there? Do different types of skill (e.g. conceptual vs. interpersonal) require different methods of training/supervision? How can we best pinpoint the difficulties trainees (or us) are having? How can we best to implement appropriately targeted training strategies, tied to the level of experience of the therapist? The therapist skill development model has the capacity to pinpoint accurately the kinds of difficulties therapists might have, and to suggest what training strategies may be most useful in overcoming them. In particular, it focuses on a rather neglected area of CBT, interpersonal skills, and provides a novel conceptualization which clarifies the relationship between different aspects of interpersonal skill, and between ‘the person of the therapist’ and ‘self-as-therapist’.
Key Learning Objectives:
The aim of the workshop is for participants to familiarize themselves with the model and use it to guide their thinking about their own development and that of supervisees/trainees. Specifically the objectives are:-
James Bennett-Levy is an experienced CBT trainer and researcher of CBT training. He has been particularly interested in self-experiential approaches to CBT training, which has led on to the development of a model of the therapist skill development that incorporates the ‘person of the therapist’ as well as the ‘self-as-therapist’. Until recently he worked at Oxford Cognitive Therapy Centre, where he was an editor of the Oxford Guide to Behavioural Experiments in Cognitive Therapy. He is now Associate Professor in Mental Health at the Northern Rivers University Department of Rural Health (Lismore), Sydney University, Australia.
Bennett-Levy, J. (2006). Therapist skills: A cognitive model of their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 34, 57-78.
Bennett-Levy, J. & Thwaites, R. (2007). Self and self-reflection in the therapeutic relationship: A conceptual map and practical strategies for the training, supervision and self-supervision of interpersonal skills. In: P. Gilbert and R. Leahy (eds): The therapeutic relationship in the cognitive behavioural therapies (p. 255-281). Routledge, London.
Thwaites, R. & Bennett-Levy, J. (2007). Conceptualizing empathy in cognitive therapy: Making the implicit explicit. Behavioural and Cognitive Psychotherapy, 35, 591-612
Enhancing Adherence with Homework Assignments in Cognitive Behavior Therapy
Nikolaos Kazantzis, School of Psychology, Massey University, New Zealand
Who the workshop is aimed at:
Nikolaos Kazantzis, PhD is a Senior Lecturer in the Clinical Psychology training program at Massey University, New Zealand, where he teaches and supervises in the Cognitive Behavior Therapy Postgraduate Diploma. He also works at public hospital and private outpatient clinics seeing adult patients in individual and group therapy formats. He is currently conducting prospective studies on enhancing homework adherence in therapy. He has editor of several books on homework in therapy. His most recent publications include several articles on the model for enhancing homework assignments taught in this workshop.
The First Six Sessions: Getting CBT for the Eating Disorders Off to a Flying Start
Glenn Waller, CNWL NHS Foundation Trust and Institute of Psychiatry, King's College London, UK
CBT is the most effective treatment for adults with eating disorders, but many patients still fail to benefit from it. In those circumstances, clinicians sometimes perseverate (ignoring evidence that things are not going well) or change tack (trying other therapies). However, it is important to recognise that there are indications in the first few CBT sessions that patients are likely to do well or poorly (e.g., failure to complete homework, poor attendance, lack of early behavioural change). The causes of such therapeutic roadblocks are likely to include a range of factors, both in the patient and the clinician. We need to learn to identify those factors, and to respond to them by returning to the principles of CBT, recognising why there is a problem, formulating it with the patient, and stressing the vital role of full participation in therapy. This workshop will focus on the vital first half dozen sessions of CBT for the eating disorders, and the skills that are needed to get therapy off to a flying start. Clinical examples will be used to demonstrate ways in which poor early progress can be identified and turned around, in collaboration with the patient.
Key Learning Objectives:
Participants will develop skills in the following domains:
Glenn Waller is a Consultant Clinical Psychologist with the eating disorders service of Central and North West London NHS Foundation Trust, where he manages the outpatient team and delivers CBT to adults with a wide range of eating disorders. He is also Visiting Professor of Psychology with the Eating Disorders Section, Institute of Psychiatry, King's College London. He has published over 200 peer-reviewed papers and book chapters, and is the lead author on a recent textbook on CBT for the eating disorders.
Cooper, M. J., Whitehead, L., & Boughton, N. (2004). Eating disorders. In: J. Bennett-Levy, G. Butler, M. Fennell, A. Hackmann, M. Mueller, & D. Westbrook (Eds). Oxford guide to behavioural experiments in cognitive therapy (pp. 267-286). Oxford, UK: Oxford University Press.
Geller, J., Williams, K.D., & Srikameswaran, S. (2001). Clinician stance in the treatment of chronic eating disorders. European Eating Disorders Review, 9, 365-373.
Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V., & Russell, K. (2007). Cognitive-behavioral therapy for the eating disorders: A comprehensive treatment guide. Cambridge, UK: Cambridge University Press.
Family-Focused Treatment for Adult and Adolescent Bipolar Patients
David Miklowitz, University of Colorado, USA
Early-onset bipolar disorder, defined as onset of mania before age 18, is a highly treatment-refractory form of the disorder marked by frequent recurrences, substantial symptom burden between episodes, social and academic dysfunction, and high suicide risk. This workshop describes an outpatient program of family-focused treatment (FFT) as an adjunct to pharmacotherapy for teenage bipolar patients (ages 13-17) who have just had an episode of mania, depression, or mixed disorder. After a brief summary of empirical findings on the efficacy of FFT for bipolar teens, the talk will focus on key therapeutic objectives and techniques: assisting families in (1) mood monitoring and identifying early warning signs of mood cycles; (2) implementing strategies to prevent full recurrences, (3) promoting consistent sleep/wake habits, (4) encouraging medication adherence, and (5) developing effective family communication and problem-solving skills to address irritability, oppositionality, and family conflict. The developmental transitions made by families in coming to accept the realities of the teen’s disorder will be discussed.
Key Learning Objectives:
To learn the research background pertinent to family-focused treatment for adolescent and adult bipolar patients
To become acquainted with the clinical methods of family-focused treatment
To learn ways to apply this treatment within clinical-community settings
Dr. Miklowitz is Professor of Psychology and Psychiatry at the University of Colorado (Boulder and Health Sciences Center Campuses), and a Senior Clinical Research Fellow in the Department of Psychiatry at Oxford University. He completed his undergraduate work at Brandeis University and his doctoral (1979-1985) and postdoctoral (1985-1988) work at UCLA. His research focuses on family environmental factors and family psychoeducational treatments for adult-onset and childhood-onset bipolar disorder.
Dr. Miklowitz has received the Joseph Gengerelli Dissertation Award from UCLA (1986), Young Investigator Awards from the International Congress on Schizophrenia Research (1987) and the National Alliance for Research on Schizophrenia and Depression (NARSAD; 1987), a Research Faculty Award from the University of Colorado (1998), and a Distinguished Investigator Award from NARSAD (2001). He is the recent recipient of the 2005 Mogens Schou Award for Research from the International Society for Bipolar Disorders. He has received funding for his research from the National Institute of Mental Health, the John D. and Catherine T. MacArthur Foundation, and the Robert Sutherland Foundation. He currently holds two major NIMH grants and two private foundation grants.
Dr. Miklowitz has published more than 170 research articles and book chapters on bipolar disorder and schizophrenia, and three books, including The Bipolar Disorder Survival Guide, a bestseller. His articles have appeared in the Archives of General Psychiatry, the American Journal of Psychiatry, the British Journal of Psychiatry, the Journal of Nervous and Mental Disease, Biological Psychiatry, the Journal of Consulting and Clinical Psychology, and the Journal of Abnormal Psychology. His book with Michael Goldstein, Bipolar Disorder: A Family-Focused Treatment Approach (Guilford), won the 1998 Outstanding Research Publication Award from the American Association for Marital and Family Therapy. His book “The Bipolar Disorder Survival Guide” is the second best-selling book on bipolar disorder, having sold over 150,000 copies. His latest book, also with Guilford, is titled The Bipolar Teen: What You Can Do to Help Your Teen and Family.
Miklowitz, DJ (2002). The Bipolar Disorder Survival Guide. NY: Guilford Press.
Miklowitz, DJ (2008): Bipolar Disorder: A Family-Focused Treatment Approach (2nd ED). NY: Guilford Press.
Miklowitz DJ & George EL (2007). The Bipolar Teen. NY: Guilford Press.
Cognitive Behavioural Analysis System of Psychotherapy: Treatment for Chronic Depression
John Swan, University of Dundee, UK & Rob Durham University of Dundee, UK
Significant numbers of people suffer from Chronic Depression in which clinically low mood and associated symptoms continue unabated for two or more years but which may become a lifelong problem without effective treatment. There is an urgent need to develop effective psychological and pharmacological treatments to meet the needs of this population. Patients with Chronic Depression present particular challenges to psychological therapists and the evidence base for standard CBT with this disorder is weak. However, a large multi-centre clinical trial has demonstrated that Cognitive Behavioural Analysis System of Psychotherapy (CBASP) can be an effective therapy for chronic depression and a group of us in Dundee have been studying this approach for several years now in collaboration with the originator of CBASP, Professor Jim McCullough. In CBASP, patients learn how their cognitive and behavioural patterns produce and perpetuate interpersonal problems and how to alter maladaptive patterns of interpersonal behaviour. CBASP focuses primarily on problematic interpersonal situations in the everyday lives of people with chronic depression using a structured intervention called situational analysis. In addition, it places considerable emphasis on the therapeutic relationship as a vehicle for change using an methodology termed disciplined personal involvement. Our clinical experience to date suggests that CBASP can be a very effective approach to a very difficult to treat disorder.
Key Learning Objectives:
To introduce participants to this new psychotherapy which is, to date, the only therapy specifically designed to meet the clinical needs of chronically depressed individuals. In this workshop we outline the therapy process and key mechanisms of change using examples to illustrate the techniques specific to CBASP. The theoretical model underpinning CBASP will be outlined. The evidence from a large clinical trial will be summarised. Learning Objectives To be introduced to and begin to understand the CBASP model. To learn about and rehearse the key mechanisms and techniques of change in CBASP . To reflect on the difficulties and problems associated with working with chronically depressed individuals.
John Swan is a clinical lecturer with the University of Dundee. He has over 20 years experience of practising CBT and in training others to practice CBT. His particular clinical and research interests centre around the psychological treatments of chronic affective disorders. He has trained with Prof JP MCCullough JR (the originator of CBASP) and is the first trained and accredited CBASP therapist in the UK. Rob Durham is a senior lecturer with the University of Dundee. He has over 20 years experience of practising CBT and in training others to practice CBT. His particular clinical and research interests centre around the psychological treatments of chronic affective disorders. He has published extensively in the research literature relating to the effectiveness of psychological treatment of GAD. He has also trained with Prof JP McCullough in Richmond, Virginia, USA.
Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, D. L., Gelenberg, A. J., Markowitz, J. C., Nemeroff, C. B., Russell, J. M., Thase, M. E., Trivedi, M. H. and Zajecka, J. (2000), A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342, 1462-70.
McCullough, J. P., Jr. (2000) Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP), Guilford, New York.
McCullough, J.P., Jr (2001) Skills Training Manual for Diagnosing and Treating Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy. The Guilford Press, New York and London
Stress Control: Large Group Didactic Therapy for the Common Mental Health Problems
Jim White, STEPS Primary Care Mental Health Team, UK
Stress Control is a robust six session didactic CBT evening class for either small or large group format anything from 6 to 120 on each course. It was designed to better meet the needs of routine clinical work. The approach has, as its basic premise, the goal of turning individuals into their own therapists. It differs from most therapies in that the role of the therapist becomes that of the teacher while the patient becomes the student. There is no discussion of personal problems on the course. This helps the individual to take responsibility for change and to attribute change to the individuals own coping skills rather than to the skill of the therapist. It is mainly used as a complete therapy but can be used alongside individual therapy. It is used for the treatment of a range of common mental health problems and assumes a negative affect approach. In particular, anxiety, depression, panic, insomnia are targeted. Spouses/partners are encouraged to attend. It attempts to teach individuals to understand their problems within both a psychological and social context. It can be used as a preventative approach. The course is free to the user and is part of a wider stepped care primary care CBT service (STEPS). The approach is clinically effective and efficient and has been extensively tested. It attempts to achieve the best compromise between best practice and best value and is able to provide help to significantly more people than can typically access more traditional approaches. A range of easily understood booklets accompany the course. The approach is increasingly used in the NHS and in Europe. We will concentrate on the latest version of this course a community-based self-referral approach that currently runs in Glasgow. This new course attracts significantly higher numbers - average size of each six session course is around 100. The majority of those who attend have self-referred.
Key Learning Objectives:
The workshop will focus on the practical aspects of setting-up and running these groups. No previous experience of group treatment is necessary.
Jim White is a consultant clinical psychologist and STEPS team leader. He is an advisor to the Scottish Government. He has worked for many years in primary care, developing services to better fit the needs of this heterogeneous population. He has presented numerous workshops and papers at national and international conferences.
White, J. (2000). Treating anxiety and stress: a group psycho-educational approach using CBT. Wiley: Chichester White, J (1997). StressPac. Harcourt
Treating Patients with Profound, Chronic, Refractory Obsessive-Compulsive (OCD) and Body Dysmorphic Disorders (BDD)
Lynne Drummond, St George's, University of London, UK &
This workshop will examine the treatment of patients with the most profound disorders and will be based on the experience of 2 clinicians who have worked with patients from throughout the Uk with these conditions for over 20 years . The workshop will be highly interactive and informal and participants will be encouraged to bring their own difficult clinical issues for discussion.
Key Learning Objectives:
NICE Guidance for BDD/OCD How assess a patient with complex problems How to apply treatment for complex OCD/BDD
Lynne M Drummond trained with Prof Isaac Marks and has run the National OCD/BDD service at South West London and St George's Mental Health Trust since 1985. She has considerable clinical experience in pragmatic treatment approaches and has published widely in the field. Anusha Pillay trained in CBT at The Institute of Psychiatry and have worked at the
National OCD/BDD service at South West London and St George's Mental
Health Trust since 2003.
DRUMMOND,L.M. (1993) The treatment of severe, chronic, resistant obsessive-compulsive disorder: An evaluation of an inpatient programme using behavioural psychotherapy in combination with other treatments. British Journal of Psychiatry,163, 223-229.
DRUMMOND,LM and FINEBERG, NA.(2006) Obsessive-compulsive disorder. The Prescriber, 17(13), 17-27.
DRUMMOND,LM;PILLAY,A; RANI,RS and KOLB PJ (2007) Specialised Inpatient Treatment for Severe, Chronic Resistant Obsessive-Compulsive Disorder (OCD); a naturalistic study of clinical outcomes. Psychiatric Bulletin. 31: 49-52.
Understanding and Treating Non-Epileptic Seizures
Non-epileptic seizures are seizures which may resemble epileptic seizures but with no recognized organic cause. They can be extremely disabling and their economic and personal costs are recognized in literature (Nowak, 1997; Martin et al., 2002). A widely accepted explanatory psychological model and treatment model do not yet exist but CBT has been shown to be effective (Chalder, 1996; Goldstein et al., 2004). Clinicians are often daunted by the lack of treatment focused literature and so do not treat NES patients, who are then forced to travel long distances to seek treatment with the few clinicians with a specific interest in and experience of treating NES. No RCTs have yet been published but some are being conducted. Explanatory models are being proposed but they are not specific to NES. Chigwedere, Chalder, Goldstein and Mellers, (in preparation) have proposed a disorder specific psychological explanatory CBT model based on clinical observations from many years of working with people with NES. The goal of the present workshop is to outline a model for understanding the disorder and to offer an opportunity to practice some interventions that have been helpful in treating NES.
Key Learning Objectives:
Craig Chigwedere is a cognitive behavioural psychotherapist and lecturer who has worked in neuropsychiatry at Maudsley Hospital and Institute of Psychiatry, London, with a special interest in NES. He is currently co-ordinating an RCT comparing CBT and Standard Treatment for treatment of NES at the Maudsley Hospital. He has recently started work at St Patrick’s Hospital, Dublin and Trinity College Dublin as a Cognitive Behavioral Psychotherapist and Clinical Lecturer.
Goldstein, L.H.; Deale A.C.; Mitchell O’Malley, S.J.; Toone, B.K.; Mellers, J.D.C. (2004) An evaluation of cognitive behavioural therapy as a treatment for dissociative seizures. Cognitive Behavioural Neurology, 17 (1), 41 49
Holmes, E. A., Brown, R., Mansell, W., Fearon, R. P., Hunter, E. A., Frasquilho, F. and Oakley, D. A. (2005). Are the two qualitatively distinct forms of dissociation? A review and some clinical implications. Clinical Psychology Review, 25, 1-23
Kanaan, R. A. A., Craig, T. K. J., Wessely, S. C. and David, A. S. (2007). Imaging repressed memories in motor conversion. Psychosomatic Medicine, 69, 2002 - 2005