PRE CONFERENCE WORKSHOPS - Wednesday 15th July - 9.30am - 5.00pm

A programme of 21 one-day Workshops which offer participants an opportunity to develop practical skills in the assessment and treatment of a range of problems. A description of each workshop is given below. The number of places is limited.


   
Workshop 1 Cognitive Therapy for Treatment Resistant Anxiety Disorders
Robert Leahy, Weill-Cornell University Medical College, USA
Workshop 2 Novel Interventions for Anxiety Disorders
Stefan Hofmann, Boston University, USA
Workshop 3 Anger Treatment: Case Formulation and the Stress Inoculation Approach
Raymond Novaco, University of California, Irvine, USA
Workshop 4
The Underdeveloped Dialectic: Dialectical Behaviour Therapy for Emotionally Constricted Personality Disorders
Thomas Lynch, University of Exeter
Workshop 5 'But OCD is My Best Friend!'
Obsessive Compulsive Disorder Treatment Across the Commitment Span

Christine Purdon, University of Waterloo, Canada
Workshop 6 Cognitive Behaviour Therapy for Clinical Perfectionism
Sarah Egan, Curtin University, Australia
Workshop 7 Using Imagery in Cognitive Therapy
Lusia Stopa, University of Southampton
Workshop 8 Cognitive Behaviour Therapy to Treat Anxious and Depressive Rumination
Edward Watkins, University of Exeter
Workshop 9 Facing Death and Other 'Realistic' Hopelessness Issues in Cognitive Behaviour Therapy
Nigel Sage, The Beacon Community Centre for Specialist Cancer and Palliative Care, Guildford, Surrey and Kathryn Mannix, Newcastle Marie Curie Centre
Workshop 10 Evidence-Based Treatments for Anxiety in Children and Adolescents
Anne-Marie Albano, University of Columbia, USA
Workshop 11
Psychological interventions for Adolescent onset Bipolar Disorder
Matthias Schwannauer, University of Edinburgh - Cancelled
Workshop 12 In the Eye of the Beholder: Individualizing Cognitive Behaviour Therapy for Body Dysmorphic Disorder
Sabine Wilhelm, Massachusetts General Hospital, USA
Workshop 13 Fitting Cognitive Therapy to the Distinctive Features of Eating Disorders
Kelly Vitousek, University of Hawaii, USA
Workshop 14 A Hard Habit to Break: New Approaches Focusing on Cognitive Factors in CBT for tic and Body-focused Repetitive Disorders
Kieron O'Connor, University of Montreal, Canada
Workshop 15 Family Interventions in Psychosis: Using a Cognitive Behaviour Therapy Framework
Fiona Lobban, Lancaster University and Christine Barrowclough, University of Manchester
Workshop 16 Collaborative Case Conceptualisation: Three Principles and Steps for Individualising Evidence-Based Treatments
Willem Kuyken, University of Exeter and Robert Dudley, Northumberland, Tyne and Wear Mental Health NHS Trust
Workshop 17 An Introduction to Compassion-focused Therapy for Shame and Self-Criticism
Paul Gilbert, University of Derby
Workshop 18 Managing Endings with Complex Cases in Primary and Secondary Care - A Cognitive Behaviour Therapy Approach
Andrew Eagle and Michael Worrell, Central and North West London NHS Foundation Trust
Workshop 19 The Cognitive Behavioural Therapist's Guide to Low-intensity Cognitive Behaviour Therapy: What Every Therapist Should Know
David Richards, University of Exeter

Workshop 20

Making Cognitive Behaviour Therapy Meaningful for People with Intellectual Disabilities
Andrew Jahoda, University of Glasgow, Carol Pert, University of Glasgow and Biza Stenfert Kroese, University of Lancaster. - Cancelled
Workshop 21 An Introduction to treating PTSD the NICE way
Deborah Lee, University of Reading

DETAILS OF EACH WORKSHOP ARE GIVEN BELOW

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Workshop 1

Cognitive Therapy for Treatment Resistant Anxiety Disorders

Robert Leahy, Weill-Cornell University Medical College, USA

Although standard cognitive behavioural therapy has shown significant effectiveness for the full range of anxiety disorders, many patients will not engage in or complete exposure. Moreover, relapse is often a common occurrence and many patients who show "improvement" may still experience intrusive thoughts and difficult emotions after "successful treatment". In this workshop we will address treatment resistant anxiety by using the following interventions: Normalize anxiety as adaptation (from an ethological perspective), use schematics to clarify the process of anxiety, and address feelings of shame. Anxious patients believe that their intrusive thoughts, images and emotions will overwhelm them, drive them "crazy", and last indefinitely. These "emotional schemas" (concepts of and strategies employed to handle emotions) perpetuate anxiety, even when nothing is happening. Often treatment resistance is maintained by anticipatory "worry" about what will happen. Worry and control are viewed by the anxious individual as productive strategies that have prevented catastrophes that have never occurred. Anxiety disorders may be viewed as a set of "rules" that lead to avoidance of danger and the maintenance of anxiety. These rules are 1.) Detect danger; 2.) Catastrophize; 3.) Try to control things; and 4.) Avoid contact. Overcoming treatment resistance involves breaking all of these "rules" in order to disconfirm the belief that "the rules have kept me safe". Anxious individuals utilize a range of strategies for mental and emotional control. These "solutions" constitute the anxiety disorder, and indeed the solution is often the problem. Helping the patient identify and relinquish "safety behaviours" (including thought- and emotion-control strategies) provides an opportunity to disconfirm the patient's "theory of anxiety", that is, a theory that one is going out of control and that danger is imminent.

Key Learning Objectives:

We will use a meta-cognitive and meta-emotional model, as well as acceptance and "cognitive-surrender" models, to overcome treatment impasses through the following: 1) Identify and modify the patient's theory of mind ; 2) Identify and modify the patient's emotional schemas; 3) Identify and relinquish safety behaviours that interfere with full exposure; 4) Elicit specific predictions about intrusions and emotions; 5) Use exposure to test predictions; and 6) Plan for relapse.

Robert L. Leahy, Director of the American Institute for Cognitive Therapy, has authored and edited eighteen books on cognitive therapy and psychological processes and is the President-Elect of the Association for Behavioural, President of the International Association for Cognitive Psychotherapy, Past-President of the Academy of Cognitive Therapy and Clinical Professor of Psychology in Psychiatry at Weill-Cornell Medical School. He is the Associate Editor of the International Journal of Cognitive Therapy. Dr. Leahy was recently elected to be President-Elect of the Association for Behavioural and Cognitive Therapy (ABCT). Dr. Leahy recently received the Aaron T. Beck Award for Outstanding Contributions in Cognitive-Behavioural Therapy. His most recent popular audience books on anxiety are The Worry Cure and Anxiety Free: Unravel Your Anxiety before it Unravels You.

Key References:

(By Robert L. Leahy): The Worry Cure: Seven Steps to Stop Worry from Stopping You; Anxiety Free: Unravel Your Anxiety before it Unravels You; Cognitive Therapy Techniques: A Practitioner's Guide;

Leahy, R. L. (2007) Emotional schemas and resistance to change in anxiety disorders. Cognitive and Behavioural Practice, 14(1), 36-45.


Workshop 2

Novel Interventions for Anxiety Disorders

Stefan Hofmann, Boston University, USA

Although CBT is more effective than placebo control conditions for the range of anxiety disorders, there is plenty of room for improvement. A particularly promising way to enhance the efficacy of existing psychological treatments is by supplementing CBT with adaptive emotion regulation strategies. Emotion regulation refers to the strategies that individuals use to modify the occurrence, experience, intensity, and expression of a wide range of emotions. These strategies seem to play an important role in anxiety disorders, which are characterized to some degree by ongoing attempts to control emotions in a variety of contexts. Individuals concerned about the expression and experience of their feelings may attempt to suppress, hide, or ignore them, with unintended consequences. Recent research provides direct evidence of the maladaptive use of emotion regulation strategies in patients with a wide range of anxiety disorders (Campbell-Sills et al., 2006a, b). This workshop will discuss strategies to directly target separate components of the emotion regulation process. These strategies include emotion exposure, preventing emotional avoidance, present-focused non-judgmental emotional awareness, antecedent cognitive reappraisal, facilitating incompatible action tendencies, and correcting distorted self-perception. These strategies are applicable to a range of anxiety disorders, including panic disorder, generalized anxiety disorders, and social anxiety disorder.

Implications: Translating recent findings from the emotion literature into clinical practice can significantly enhance the efficacy of CBT strategies for anxiety disorders. These strategies can be integrated into any of the existing CBT approaches.

Key Learning Objectives:

  1. Identifying emotional dysregulation in specific anxiety disorders
  2. Developing strategies to correct emotional dysregulations within a CBT framework
  3. Tailoring adaptive emotion regulation strategies to particular clients

Professor Stefan G. Hofmann is Professor of Clinical Psychology at Boston University Massachusetts, USA, where he directs the Psychotherapy and Emotion Research Laboratory. He authored more than 100 scientific papers and 6 books, primarily in the field of anxiety disorders and emotion studies. His research is supported by the National Institute of Mental Health and various private foundations.

Key References:

Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. (2006a). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6, 587-595.

Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006b). Effects of suppression and acceptance on emotional responses in individuals with anxiety and mood disorders. Behavior Research and Therapy, 44, 1251-1263.

Hofmann, S. G. & Asmundson, G. J. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28, 1-16.

Hofmann S. G. & Otto, M. W. (2008). Cognitive-behavior therapy of social anxiety disorder: Evidence-based and disorder specific treatment techniques. New York, NY: Routledge.

Hofmann, S. G., Moscovitch, D. A., Litz, B. T., Kim, H.-J., Davis, L., & Pizzagalli, D. A. (2005). The worried mind: Autonomic and prefrontal activation during worrying. Emotion, 5, 464-475.

Hofmann, S. G. & Smits, J. A. J. (2008). Cognitive-Behavioral Therapy for adult anxiety disorders: A meta-analysis of randomized placebo controlled trials. Journal of Clinical Psychiatry, 69, 621-632.


Workshop 3

Anger Treatment: Case Formulation and the Stress Inoculation Approach

Raymond Novaco, University of California, Irvine, USA

Anger dysregulation occurs in various personality, psychosomatic, and conduct disorders, in schizophrenia, in bipolar mood disorders, in organic brain disorders, in impulse control dysfunctions, and in a variety of conditions resulting from trauma. Anger treatment should be grounded in assessment of anger control deficits and be case formulated. Psychometric, staff-rated, and interview methods will be presented and case formulation practised using an anger dysregulation model. CBT anger treatment based on the “stress inoculation” approach will presented and practised, including cognitive restructuring, arousal reduction techniques in conjunction with provocation hierarchy procedure, and the use of role play to foster behavioural coping skills.

Obtaining leverage for change through a “preparatory phase” will be covered, including application to developmentally disabled clients. Achieving therapeutic change by addressing symbolic structures associated with anger and aggression will be presented. Interface of this individual-based approach with a group-based treatment will be illustrated. Getting treatment engagement with chronically anger people presents multiple challenges, especially if they are seriously disordered and historically assaultive. Cognitive-behavioural anger treatment has demonstrated efficacy with patients in secure hospitals, patients with developmental disabilities, and a variety of community outpatients, including clients with high levels of work stress, major depressive disorder, intermittent explosive disorder, posttraumatic stress disorder, domestic violence problems, and “road rage”. The workshop will enhance proficiency in anger assessment and case formulation and provide a CBT skill set that can be implemented as a full protocol or in modular form. Participants will be coached in the implementation of the stress inoculation approach to anger treatment

Key Learning Objectives:

  1. Familiarity with anger self-report and staff-rated psychometric instruments and their clinical use
  2. Ability to implement client self-monitoring procedures
  3. Use of an imaginal provocation test for anger to assess treatment gains
  4. Ability to do case formulation from anger assessment and anger dysregulation model
  5. Proficiency in arousal reduction techniques, including breathing, muscle relaxation, and imagery
  6. Cognitive restructuring for anger experiences, with attention to key symbolic structures
  7. Proficiency in provocation hierarchy procedures in stress inoculation format

Professor Ray Novaco pioneered the cognitive-behavioural treatment of anger and coined the term “anger management”. His ongoing research includes treatment studies in Scotland and England with patients in forensic facilities, combat veterans with severe PTSD, and women and children in domestic violence facilities

Key References:

Novaco, R. W. (2007). Anger dysregulation. In T. Cavell & K. Malcolm, Anger, aggression, and interventions for interpersonal violence (pp. 3-54). Mahwah, NJ: Erlbaum.

Taylor, J. L., & Novaco, R. W. (2005). Anger treatment for people with development disabilities. Chichester, England: Wiley.

Novaco, R. W. (2003). The Novaco Anger Scale and Provocation Inventory Manual. Los Angeles: Western Psychological Services.


Workshop 4

The Underdeveloped Dialectic:
Dialectical Behaviour Therapy for Emotionally Constricted Personality Disorders

Thomas Lynch, University of Exeter

Dialectical Behavior Therapy (DBT) was originally designed as a treatment of emotionally dysregulated, impulsive, and dramatic disorders (e.g. borderline personality disorder) and populations (e.g., parasuicidal women). However, a number of complex disorders represent the dialectical opposite of BPD and related disorders; i.e., characterized as over-controlled, emotionally constricted, perfectionistic, and highly risk-averse. Based in part on the findings from two randomized clinical trials, this seminar will describe an adaptation of DBT that targets cognitive/behavioral rigidity and emotional constriction. Interventions are designed to maximize openness/flexibility and reduce rigid thinking/ behavior, as opposed to the primary orientation in standard DBT of reducing impulsive behavior and tolerating extreme emotions. New skills include a Radical Openness module that includes loving-kindness/forgiveness training and new mindfulness “states of mind” designed to help the client find balance in the rigidity/openness continuum. It is recommended that participants have a moderate level of understanding of Standard DBT (for BPD) in order to get the most out of this seminar.

Key Learning Objectives:

  • Participants will learn new DBT Radical Openness skills useful for treating emotionally constricted and risk averse personality disorders.
  • Participants will be able to identify new DBT treatment targets and dialectical dilemmas for working with emotionally constricted and risk-averse personality disorders.
  • Participants will learn loving-kindness forgiveness interventions and other related positive mood induction methods designed to enhance in-vivo exposure exercises for emotionally constricted and risk-averse personality disorders.

Professor Lynch is a research clinical psychologist and Professor of Clinical Psychology in the Mood Disorders Centre in the School of Psychology at the University of Exeter. He is currently Professor and Director of the Dialectical Behaviour Therapy Research and Training Program in the Mood Disorders Centre in School of Psychology at University of Exeter, and Academic Lead for Human Sciences at the Peninsula College of Medicine and Dentistry. Professor Lynch is an international trainer in Dialectical Behaviour Therapy

Key References:

Lynch, T.R., Morse, J.Q., Mendelson, T., & Robins, C.J. (2003). Dialectical Behavior Therapy for depressed older adults: A randomized pilot study. The American Journal of Geriatric Psychiatry, 11, 1-13.

Lynch, T.R., Cheavens J.S., Cukrowicz K.C., et al. (2007). Treatment of older adults with co-morbid personality disorder and depression: A Dialectical Behavior Therapy approach. International Journal of Geriatric Psychiatry, 22, 131-143.

Lynch, T.R., & Cheavens, J. S. (2007). Dialectical Behavior Therapy for depression with co-morbid personality disorder: An extension of standard DBT with a special emphasis on the treatment of older adults. In L. A. Dimeff & K. Koerner (Eds.), Dialectical Behavior Therapy in Clinical Practice: Applications Across Disorders and Settings (pp. 264 - 297). New York: Guilford.

Lynch, T. R., & Cheavens, J.S. (2008). Dialectical behavior therapy for co-morbid personality disorders. Journal of Clinical Psychology, 64, 1- 14.


Workshop 5

'But OCD is My Best Friend!'
Obsessive Compulsive Disorder Treatment Across the Commitment Span

Christine Purdon, University of Waterloo, Canada

In this interactive workshop we will discuss case formulation, treatment planning and treatment strategies for individuals with straightforward and complex presentations of OCD, and varying degrees of commitment to change. The central goal of the workshop is to help attendees develop a framework for conceptualizing and overcoming complexities in OCD treatment. The morning session will focus on models of OCD, case formulation and treatment planning, covering basic treatment of OCD. Case studies will then be presented and attendees invited to work in pairs or groups discussing and developing case formulations and treatment plans, while anticipating possible treatment challenges. In the afternoon session, we will discuss treatment ambivalence, the ways it is manifested and models for understanding it. Client and therapist factors will be discussed. Attendees will be invited to share treatment challenges they have had and we will generate strategies for conceptualizing and managing these challenges

Key Learning Objectives:

The central goal of the workshop is to help attendees develop a framework for conceptualizing and overcoming complexities in OCD treatment.

Dr. Christine Purdon is an Associate Professor in the Department of Psychology at the University of Waterloo. Dr. Purdon started her career at UW in 1997 after completing her pre-doctoral internship at the Centre for Addiction and Mental Health in Toronto under the supervision of Dr. Martin Antony. Her research currently examines factors involved in the persistence of compulsions, as well as continues her work on mental inhibition as it pertains to the persistence of obsessions. Dr. Purdon teaches cognitive-behaviour therapy in UW's PhD program in clinical psychology and she also holds a private practice in which she assesses and treats OCD.

Key References:

Antony, M., Purdon, C., & Summerfeldt, L. (Eds.) (2006). Cognitive-Behavioral Treatment of Obsessive Compulsive Disorder: Beyond the Basics. American Psychological Association Press.

Purdon, C., & Clark, D. A. (2005). Overcoming obsessions. Oakland: New Harbinger.

Rachman, S. J. ( 2003). The treatment of obsessions. Oxford, UK: Oxford University Press.

Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, S29-S52.

Steketee, G. (1999). Overcoming obsessive-compulsive disorder: A behavioral and cognitive protocol for the treatment of OCD. Oakland, CA: New Harbinger.


Workshop 6

Cognitive Behaviour Therapy for Clinical Perfectionism

Sarah Egan, Curtin University, Australia

Clinical perfectionism involves the setting of and striving for self imposed, demanding standards and the evaluation of self-worth based on the achievement of standards (Shafran, Cooper, & Fairburn, 2002). Clinical perfectionism is important to target as a transdiagnostic factor across disorders. Perfectionism has been found to interfere with treatment response in depression, to be a risk factor in the development of eating disorders and to be associated with higher levels of comorbidity in anxiety disorders. Preliminary studies indicate that targeting clinical perfectionism can produce significant decreases in perfectionism and anxious, depressive and eating disorder symptomatology.

This workshop will provide participants with an understanding of the maintenance of clinical perfectionism and the relevance of targeting clinical perfectionism as a transdiagnostic maintaining mechanism across depression, eating disorders and anxiety disorders. A cognitive-behavioural model of the maintenance of clinical perfectionism (Shafran et al., 2002) will be utilised to understand the different maintaining factors including cognitive (e.g., dichotomous thinking, attention biases, self criticism) and behavioural factors (e.g., avoidance, performance checking, procrastination, safety behaviours).

The major part of the workshop will be devoted to training and practice of cognitive behavioural techniques to overcome clinical perfectionism. This will include techniques to enhance clients understanding of clinical perfectionism, for example, cognitive-behavioural formulation of their clinical perfectionism, self-monitoring and addressing ambivalence towards change. Strategies to address behavioural avoidance in clinical perfectionism will be practiced by participants. Techniques to address perfectionistic predictions and self-criticism will also be discussed and practiced. The importance of changing self-evaluation in clinical perfectionism will also be included.

Key Learning Objectives:

The aims of this workshop are for participants to;

  1. Understand the cognitive-behavioural model of clinical perfectionism.
  2. Understand the relevance of clinical perfectionism to a range of psychological disorders
  3. Learn to do a cognitive-behavioural formulation of clinical perfectionism
  4. Learn techniques in self-monitoring and assessing clinical perfectionism
  5. Learn how to enhance motivation to change clinical perfectionism
  6. Learn strategies in changing unhelpful behaviours in clinical perfectionism (e.g., avoidance, safety behaviours)
  7. Learn strategies for intervening with perfectionistic predictions and self-criticism
  8. Learn strategies for helping to broaden self-evaluation

Sarah Egan, PhD is a lecturer in the clinical psychology training program at Curtin University, Australia, where she teaches and supervises in clinical psychology and cognitive behavioural therapy. She is also a registered clinical psychologist and maintains an active clinical practice. Her research has focused on cognitive-behaviour therapy for anxiety disorders and perfectionism and she has published and delivered conference presentations and workshops in this area for national and international audiences. She is the past national president of the Australian Association for Cognitive and Behaviour Therapy (AACBT), is the Australian representative on the World Congress of Behavioural and Cognitive Therapies, has served as the Australian representative on the Organising Committee for the Barcelona World Congress of Behavioral and Cognitive Therapies and is the Scientific Convenor for the 2009 AACBT conference.

Key References:

Egan, S.J., & Hine, P. (in press). Cognitive behavioural treatment of perfectionism: A single case design series. Behaviour Change.

Egan, S.J., Piek, J.P., Dyck, M.J., & Rees, C.S. (2007). The role of dichotomous thinking and rigidity in perfectionism. Behaviour Research and Therapy, 45, 1813-1822.

Glover, D.S., Brown, G.P., Fairburn, C.G., & Shafran, R. (2007). A preliminary evaluation of cognitive-behaviour therapy for clinical perfectionism: A case series. British Journal of Clinical Psychology, 46, 85-94.

Riley, C., Lee, M., Cooper, Z., Fairburn, S., & Shafran, R. (2007). A randomized controlled trial of cognitive-behaviour therapy for clinical perfectionism: A preliminary study. Behaviour Research and Therapy, 45, 2221-2231.

Shafran, R., Cooper, Z., & Fairburn, C.G. (2002). Clinical perfectionism: a cognitive-behavioural analysis. Behaviour Research and Therapy, 40, 773-791.

Steele, A.L., & Wade, T.D. (2008). A randomized trial investigating guided self-help to reduce perfectionism and its impact on bulimia nervosa: A pilot study. Behaviour Research and Therapy, 46, 1316-1323.


Workshop 7

Using Imagery in Cognitive Therapy

Lusia Stopa, University of Southampton

Images are important in cognitive therapy because of their role in the maintenance of clinical problems and because they can be harnessed to treat those problems. Images can occur in any sensory modality and can contain multiple meanings as well as being frequently associated with high levels of affect. Images can represent feared objects or situations, but they can also represent feared aspects of the self. There is a clear link between traumatic memories and intrusive images in PTSD, but images are often a link to earlier memories in a number of other disorders. For example, there is growing evidence that distorted images of self in social phobia are linked to early memories of being humiliated in social situations. There are a number of imagery techniques that have been developed in cognitive therapy since its inception. However, many therapists are not familiar with these techniques or feel reluctant to use them. In this workshop, we look at a number of imagery techniques, discuss when to use them, identify therapist beliefs and assumptions that create obstacles to using imagery, and practise using some of the techniques themselves. We will focus on the following techniques: i) imaginal exposure to specific stimuli ii) imaginal rehearsal iii) guided imagery iv) imaginal reliving of traumatic memories v) imagery rescripting

Key Learning Objectives:

  1. To understand why imagery is important and when and how to use imagery in treatment
  2. To gain practice in using a number of different imagery techniques
  3. To overcome obstacles to using imagery in CBT interventions

Imagery interventions provide therapists with powerful tools to use either in association with more traditional CBT techniques or as major interventions in their own right. This workshop should provide therapists with knowledge of imagery interventions and the confidence to use them in their own practice.

Lusia Stopa is Director of the University of Southampton PG Diploma in Cognitive Therapy. She is a Clinical Psychologist who has been practising, researching and teaching cognitive therapy for over 20 years. Her current interests focus on how imagery represents the self and how these images of self can contribute to the maintenance of disorders. She is the editor of a book on this topic: Imagery and the threatened self: perspectives on mental imagery and the self in cognitive therapy (Routledge). She is also conducting research into how imagery rescripting works.

Key references

Hackmann, A. & Holmes, E. (2004). Reflecting on imagery: A clinical perspective and overview of the special issue of Memory on mental imagery and memory in psychopathology. Memory, 12, 389-402.

Smucker, M. R. & Niederee, J. (1995). Treating incest-related PTSD and pathogenic schemas through imaginal exposure and rescripting.Cognitive and Behavioral Practice, 2, 63-92.

Wild, J., Hackmann, A., & Clark, D. M. (2007). When the present visits the past: Updating traumatic memories in social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 38, 386-401.


Workshop 8

Cognitive Behaviour Therapy to Treat Anxious and Depressive Rumination

Edward Watkins, University of Exeter

Rumination has been identified as a core process in the maintenance and onset of depression (Nolen- Hoeksema, 1991; 2000) and as a possible mechanism contributing to co-morbidity (Harvey et al., 2004). Furthermore, rumination seems to be a difficult-to-treat symptom, which is associated with poorer outcomes for psychological therapy. This workshop will illustrate how the CBT approach can be modified to reduce rumination in chronic, recurrent and residual depression, using new approaches derived from clinical experience and experimental research. A programme of research by Dr Watkins has suggested that the thinking style adopted during rumination can determine whether it has helpful or unhelpful consequences on social problem solving (Watkins & Moulds, 2005) and emotional processing (Watkins, 2008). This experimental work has inspired a novel approach to treating depression, called Rumination-focused CBT, which focuses on changing the process of thinking, rather than simply changing the content of thinking, in order to be more effective in successfully reducing rumination and treating depression. There is now empirical backing for the efficacy of this approach for difficult-to-treat patients in terms of a positive open case series and randomised controlled trial funded by NARSAD. The workshop will review the theoretical background and core techniques of the therapy, including functional analysis of thinking style, behavioural activation, use of imagery, experiential exercises and behavioural experiments to coach patients to shift to more adaptive styles of thinking. This workshop has been successfully received at a number of BABCP and EABCT events.

The workshop is designed for therapists with an intermediate knowledge of CBT.

Key Learning Objectives:

  1. To review the theory and research relevant to depressive rumination
  2. To review the rumination-focused CBT approach, including behavioural activation, functional analysis, modifying thought-form-process, training in shifting thinking style, experiential exercises that counter rumination including relaxation, mental absorption and compassion
  3. To illustrate treatment approaches to depressive rumination via video and experiential approaches
  4. Workshop attendees will be able to describe the nature and consequences of rumination in depression.
  5. Workshop participants will have insight into CBT approaches for rumination in depression.
  6. Workshop participants will practise novel process-focused techniques for changing patients’ relationship to their ruminative thoughts.

Dr Watkins is Professor in Clinical Psychology at the School of Psychology, University of Exeter and co-director of the Mood Disorders Centre, University of Exeter. Previously Dr Watkins was research fellow for cognitive clinical psychology of depression, a joint post between the Institute of Psychiatry, London and the MRC Cognition and Brain Sciences Unit, Cambridge. Dr Watkins has received specialist training in CBT and was previously a supervisor on the MSc course for CBT at the Institute of Psychiatry, and a therapist on the recently completed randomised controlled trial of CBT for bipolar affective disorder (Lam et al., 2003). Dr Watkins currently holds a Wellcome Project Grant to investigate cognitive processes in depressive rumination and a MRC Experimental Medicine grant to investigate novel self-help treatments for depression. In 2004, Dr Watkins was awarded British Psychological Society's May Davidson Award for "outstanding contribution to the development of clinical psychology within the first 10 years of qualification".

Key References:

Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford University Press.

Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety depressive symptoms. Journal of Abnormal Psychology, 109, 504-511

Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569-582.

Watkins, E.R., & Moulds, M. (2005). Distinct modes of ruminative self-focus: Impact of abstract versus concrete rumination on problem solving in depression. Emotion, 5, 319-328


Workshop 9

Facing Death and Other 'Realistic' Hopelessness Issues in Cognitive Behaviour Therapy

Nigel Sage, The Beacon Community Centre for Specialist Cancer and Palliative Care, Guildford, Surrey and Kathryn Mannix, Newcastle Marie Curie Centre

Many skilled CBT therapists are used to dealing with clinical depression and the associated distorted cognitions of loss of hope and lack of sense of future. However, when the patient has a rational basis for these beliefs does the therapist have any tools to help? Also how does a CBT therapist offer support and supervision to that growing number of health care professionals not working in mental health who use a cognitive behavioural approach in physical health care including palliative care in an attempt to support people who are facing challenges that overwhelm them with “realistic” negative thoughts?

Content:

  1. Examine research evidence for using CBT to help people experiencing major adverse life events, including life changing illness.
  2. Consider the concepts of Self-efficacy, Hopelessness, Purposelessness and Pessimism
  3. Identify personally challenging clinical situations to examine in detail
  4. Understand the unhelpful cognitions that deskill the therapist
  5. Develop effective strategies for “therapist recovery”
  6. Adapt CBT methods to the needs of situations that have been “realistically” appraised to be hopeless
  7. Identifying the psychological needs of people in adversity
  8. Developing safe and supportive CBT supervision for “non-therapists”

There are three groups to whom this workshop may be of particular interest:

  1. CBT practitioners working with clients whose adverse circumstances seem to place them beyond being helped psychologically should find this useful. The workshop will be of special interest to those working with physical disability and palliative care.
  2. CBT practitioners interested in providing supervision to non-therapist health care professions should find the workshop a source of information that enables them to orientate themselves to the key issues encountered by their supervisees.
  3. Health care professionals who have attended previous training courses organised by the workshop leaders and who would value the opportunity for a recap and refresher event on applying a cognitive behavioural approach.

Key Learning Objectives:

Participants will learn to apply CBT skills to situations that the therapist finds difficult to manage because of the daunting nature of the reality of the personal situation of the client, and learn to provide supervision to health care professionals who are using a cognitive behavioural approach (but are not therapists) in challenging situations outside of mental health services

Kathryn Mannix is a Consultant in Palliative Medicine at the Royal Victoria Infirmary, Newcastle upon Tyne, and the Newcastle Marie Curie Centre. She is a qualified cognitive therapist and runs a cognitive therapy service for palliative care patients from the Marie Curie Centre. Her research interests include: application of cognitive behaviour therapy in a palliative care setting, palliation of nausea and vomiting and management of breathlessness. Publications include an evaluation of the effectiveness of brief CBT training for palliative care practitioners.

Nigel Sage is Consultant Clinical Psychologist and in Cancer and Palliative Care at The Beacon Community Centre for Specialist Cancer and Palliative Care in Guildford, Surrey providing clinical services to patients and carers that include individual therapy, CBT group therapy and psycho-educational discussion groups. He has run a series of training courses in CBT for specialist health care staff working in cancer and palliative care and has recently published a book based on this course material.

Key References:

Mannix, K.; Blackburn, I-M.; Garland, A.; Gracie, J.; Moorey, S.; Reid, B.; Standart, S. and Scott, J. (2006) Effectiveness of brief training in cognitive behaviour therapy techniques for palliative care practitioners. Palliative Medicine; 20: 579-584

Sage, N.; Sowden, M.; Chorlton, E. and Edeleanu, A. (2008) CBT for Chronic Illness and Palliative Care: A workbook and toolkit Chichester: WileyBlackwell

Snyder, C. and Lopez, S. eds (2005) Handbook of Positive Psychology New York: OUP - especially Chapters 15, 17, 19 and 20


Workshop 10

Evidence-Based Treatments for Anxiety in Children and Adolescents

Anne-Marie Albano, University of Columbia, USA

Contrary to popular belief, anxiety and worry in children do not signify “just a phase” to be “grown out of” with relative ease. Separation, social and generalized anxiety disorders are real and impairing conditions, and often go unrecognized and untreated for many years in children. Epidemiological surveys place the prevalence of anxiety disorders in youth to be greater than 10%, with surveys conducted in the United States suggesting that 10%-to-20% of youth are affected by these disorders. Anxiety disorders are among the most common reason for mental health referrals for youth, and are often associated with high comorbidity with each other and with other internalizing disorders such as depression. As such, anxiety may interfere with development, school achievement, social and family functioning. Anxiety disorders in youth are not only associated with the continuation of anxiety into adulthood, but also with later major depression, suicide attempts, substance abuse and long term service utilization. This workshop is focused on the current status of evidence-based cognitive behavioral treatments for the most common triad of anxiety disorders in youth, separation anxiety disorder, social anxiety disorder and generalized anxiety disorder. The program begins with an overview of the psychopathology of these common and coexisting childhood anxiety disorders and presents diagnostic and assessment methods for clinical practice. The main focus of the workshop is a detailed presentation of the components of cognitive behavioral therapy for anxiety in youth, followed by a review of the foundations for empirical support for cognitive behavioral treatment for childhood anxiety. Involvement of parents in treatment, school issues, developmental considerations and combining CBT with medications will also be discussed. Findings from the extant literature including the recent Child/Adolescent Anxiety Multimodal Study (CAMS), will be presented.

Key Learning Objectives:

1. Understand the psychopathology of anxiety in youth and its sequelae.

2. Become familiar with empirically supported methods of assessment and diagnosis.

3. Learn the basic elements of the cognitive behavioral treatment programs for anxiety concerns, and when to apply these components in a comprehensive treatment plan:

  1. Psychoeducation
  2. Somatic management techniques
  3. Cognitive interventions
  4. Exposure based methods
  5. Parents in the treatment process
  6. Classroom management
  7. Relapse prevention

4. Understand optimal and innovative ways to involve parents and other family members in the recovery process.

5. Become versed in the standards for empirically supported treatments and the current status of treatment for youth with anxiety disorders.

Anne Marie Albano is Associate Professor of Clinical Psychology in Psychiatry at Columbia University. She received her Ph.D. from the University of Mississippi, interned at the Boston-VA/Tufts Consortium, and completed a postdoctoral fellowship at the Center for Stress and Anxiety Disorders at SUNY Albany. She is a Founding Fellow of the Academy of Cognitive Therapy, a Beck Institute Scholar, and is Board Certified in Clinical Child and Adolescent Psychology. She is also secretary for Division 53 of the APA. Dr. Albano is the immediate past president of the Association for Behavioural and Cognitive Therapies (ABCT). She also served ABCT as Editor of Cognitive and Behavioural Practice, and Representative at Large. She is a Principal Investigator for the NIMH multisite "Child/Adolescent Anxiety Multimodal Treatment Study" and was a PI for the landmark NIMH "Treatments for Adolescents with Depression Study" (TADS). She presently is the head of clinician training for the Evidence Based Treatment Dissemination Center, a New York State Office of Mental Health initiative to bring effective treatments to community clinicians. Anne Marie has co-developed a cognitive behavioural treatment program for adolescents with social phobia, and is the co-author of a treatment manual and parent guide for school refusal behaviour. In addition, she is the co-author of the Anxiety Disorders Interview Schedule for Children. Anne Marie has authored over 80 articles and chapters, conducts clinical research, supervises the research and clinical development of Interns and postdoctoral fellows in psychology and psychiatry, and is involved in advanced training of senior clinicians in CBT.


Workshop 12

In the Eye of the Beholder: Individualizing Cognitive Behaviour Therapy for Body Dysmorphic Disorder

Sabine Wilhelm, Massachusetts General Hospital, USA

Body Dysmorphic Disorder is characterized by a preoccupation with imagined or slight defects in physical appearance. The appearance concerns lead to significant distress and/or social or occupational impairment. The most common appearance preoccupations involve the face or head, including the skin (e.g., scarring), hair (e.g., thinning hair), or nose (e.g., shape or size), but any body part may be the focus of concern. Individuals with BDD frequently engage in repetitive behaviors (e.g., mirror checking, comparing themselves to others, camouflaging) and often avoid social situations. BDD is relatively common and it affects approximately 0.7-3% of the population.

The purpose of this workshop is to provide information on empirically-validated cognitive-behavioral interventions designed to help individuals with BDD. The presenter will first describe how to correctly recognize, diagnose, and conceptualize individuals with BDD. Participants will then learn a range of therapeutic techniques including: cognitive strategies for delusional and non-delusional BDD, metaphors and mindfulness exercises, exposure and response prevention exercises, mirror retraining, and strategies for involving patients' families. In addition, motivational strategies for helping patients overcome resistance to treatment will be presented. Finally, techniques for overcoming specific BDD symptoms such as skin picking or “doctor shopping,” as well as relapse prevention strategies, will be discussed. The workshop is aimed at: Mental health service providers with low or moderate familiarity with Cognitive Behavioral Therapy for Body Dysmorphic Disorder.

Key Learning Objectives:

  • How to recognize, diagnose, assess and conceptualize BDD
  • How to engage a patient in CBT for BDD
  • How to design various cognitive and behavioral treatment strategies, which will allow the patient to develop new ways of thinking as well as new ways of behaving

Sabine Wilhelm is an Associate Professor at the Harvard Medical School and Director of the Obsessive Compulsive Disorder (OCD) and Related Disorders Program at the Massachusetts General Hospital. She is the principal investigator of several NIMH-funded clinical research studies focusing on the treatment of Body Dysmorphic Disorder, OCD and Tic Disorders. She also recently authored a self-help book for individuals with body image problems and several other books focusing on the treatment of OCD and tics.

Key References:

Phillips K.A., Didie, E.R., Feusner, J., Wilhelm, S. (2008). Body dysmorphic disorder: Treating an underrecognized disorder. Am J Psychiatry, 165, 1111-1118.

Veale, D. (2004). Advances in a cognitive behavioural model of body dysmorphic disorder. Body Image, 1, 113-125.

Wilhelm. S. (2006). Feeling good about the way you look: A program for overcoming body image problems. New York, NY: Guilford Press.


Workshop 13

Fitting Cognitive Therapy to the Distinctive Features of Eating Disorders

Kelly Vitousek, University of Hawaii, USA

Cognitive-behavioral therapy (CBT) is the most effective tested treatment for the eating disorders. Many clinicians, however, consider the approach insufficient for anorexia nervosa (AN) and perhaps ill-suited to the challenges it presents. Therapists with experience in applying CBT to other populations find that robust treatment principles don't seem to hold for AN. For example, exposure frequently fails to diminish patients' anxiety; distorted beliefs seem impervious to cognitive restructuring. This workshop will focus on addressing the difficulties that complicate the use of CBT (and most other treatment modalities) for individuals with AN and related eating disorders that involve low weight. Three distinctive features will be emphasized: the positive evaluation of symptoms, the hard-wired effects of hunger and semi-starvation, and the high levels of effort required to sustain anorexic behavior. Each of these key elements has direct implications for the design and delivery of more effective interventions for AN and related eating disorders. Specific recommendations for adapting CBT to the distinctive characteristics of AN will be provided, with numerous clinical examples from adolescent and adult patients.

Key Learning Objectives:

  1. Participants will become more familiar with several key phenomena that complicate the treatment of anorexia nervosa and related eating disorders
  2. Participants will learn how to adapt the style, focus, and techniques of CBT to better fit these distinctive features
  3. Participants will gain experience in using values-related strategies to increase motivation for change in eating-disordered individuals
  4. Participants will recognize opportunities for incorporating more behavioral experiments and in vivo exercises in CBT for AN and related eating disorders

Kelly Vitousek is an Associate Professor of Psychology and Clinical Associate Professor of Psychiatry at the University of Hawaii. She is Co-Director of the Center for Cognitive-Behavioral Therapy in Honolulu, and Director of the Eating Disorder Program. Her interests include motivational issues in the treatment of eating disorders, cognitive-behavioral therapy for anorexia nervosa, and patterns of extreme overvalued behavior in non-clinical populations, including high-altitude mountain climbers and practitioners of calorie restriction for longevity.

Key References:

Fairburn, C. G. (2008). Cognitive-behavioral therapy and eating disorders. New York: Guilford.

Vitousek, K., Watson, S., & Wilson, G. T. (1998). Enhancing motivation for change in treatment-resistant eating disorders. Clinical Psychology Review, 18, 391-420.


Workshop 14

A Hard Habit to Break: New Approaches Focusing on Cognitive Factors in CBT for tic and Body-focused Repetitive Disorders

Kieron O'Connor, University of Montreal, Canada

Cognitive behavioural techniques for treating tics and body focused habit disorders have existed for over 30 years and are centred around habit reversal techniques largely inspired by learning models. More recent models emphasize the role of both cognitive and psychophysiological factors such as heightened sensori-motor activation in provoking tics and repetitive behaviours, and maintaining the tic tense-release cycle. The present workshop presents a cognitive psychophysiological model of tic onset and an empirically validated multicomponent program employing cognitive, behavioural and psychophysiological techniques for controlling tics and associated body focused habit disorders such as hair pulling, nail biting, knuckle cracking, teeth grinding, skin picking and scratching. The program follows 10 steps: (i) awareness training (functional analysis); (ii muscle retraining; (iii) relaxation; (iv) reducing sensori-motor activation; (v) modifying style of planning action; (vi) cognitive restructuring; (vii) behavioural restructuring; (viii) cognitive and behavioural restructuring in high risk situations; (ix) generalization to other tics; and (x) relapse prevention. Although the program has been validated on adults and adolescents, it can be adapted to children.

Unlike other behavioural programs such as habit reversal, the present model aims to prevent tic onset by overall cognitive and behavioural restructuring of sensori-motor activation, rather than reverse, impede or modify the tic movement.

Participants will acquire the following skills:

  1. Cognitive, behavioural and clinical evaluation procedures and instruments
  2. Methods for identifying and measuring tics
  3. Psychoeducation techniques
  4. Cognitive and meta-cognitive restructuring (beliefs about tics)
  5. Cognitive behavioural restructuring in high risk situations/activities
  6. Modifying counter-productive strategies maintaining tense-release cycles
  7. Techniques for improving sensori-motor regulation

Key Learning Objectives:

Participants will be able to:

  1. Identify and distinguish tics and habits from other repetitive behaviours
  2. Understand the psychological and behavioural dimensions of tic and habit disorders
  3. Apply effective intervention for simple and complex tics and behaviours

Kieron O'Connor (Clinical Psychologist) works as a researcher and practitioner in obsessional compulsive disorder, delusional disorder, tic disorder, and Tourette syndrome. He is director of the OCD study centre at Fernand-Seguin Research Centre in Montreal, University of Montreal, and is also professor at the University of Quebec at Outaouais, Canada. He has published over 140 peer reviewed publications and 8 books. He is particularly concerned to develop and integrate new methods of evaluation and interventions for treatment resistant cases

Key References:

O'Connor, K.P., Brault, M., Loiselle, J., Robillard, S., Borgeat, F., and Stip, E. (2001). Evaluation of a cognitive-behavioral program for the management of chronic tic and habit disorders. Behavior Research & Therapy, 39, 667-681.

O'Connor, K.P. (2002). A cognitive behavioral/psychophysiological model of tic disorders. Invited Essay. Behavior Research and Therapy, 40, 1113-1142.

O'Connor, K.P. (2005). Cognitive behavioral management of tic disorders. John Wiley & Sons.

O'Connor, K.P., Lavoie, M.E., Stip, E., Borgeat, F., and Laverdure, A. (2008). Cognitive-behaviour therapy and skilled motor performance in adults with chronic tic disorder. Neuropsychological Rehabilitation, 18, 45-64.


Workshop 15

Family Interventions in Psychosis: Using a Cognitive Behaviour Therapy Framework

Fiona Lobban, Lancaster University and Christine Barrowclough, University of Manchester

In the last 20 years there has been a great deal of success in developing cognitive behavioural models to understand psychosis. These have been used to develop effective interventions for individuals. There has been a relative lack of progress in developing theoretical models that can guide or work with families. This is despite strong evidence for the importance of family responses to outcome (Butzlaff & Hooley, 1998) and the potential to improve outcome by working with families (Pfammatter et al 2006; Pharoah, et al 2006). Consequently, many families do not receive adequate interventions in the NHS, despite the NICE Guidelines stating that this should be offered to every family in which there is a risk of relapse (NICE 2003). In this workshop we aim to present a cognitive model of family responses to psychosis, which is based on an illness cognition framework. There is good evidence to show that the relationship between symptom severity and relatives' responses is mediated by the beliefs the relatives hold about the psychosis and related behaviour. This offers an opportunity to develop clinical interventions that use cognitive and behavioural techniques to help relatives to develop models of psychosis that reduce their distress and allow them to support their family member most effectively.

A key advantage of this approach is that it builds directly on the CBT skills that many clinicians in the NHS already possess, and will hopefully increase the confidence of staff to offer family interventions within routine clinical work. It also facilitates the integration of individual and family work within a common CBT model.

Key Learning Objectives:

  1. Identifying key illness cognitions
  2. Formulating family difficulties within a CBT framework
  3. Strategies to modify unhelpful cognitions in family members
  4. Integrating individual and family CBT
  5. Identifying barriers to offering family interventions in routine practice.

Professor Christine Barrowclough is Professor of Clinical Psychology at the University of Manchester, UK. She has over 25 years clinical and research experience in the development and evaluation of psychological approaches to working with families of people with psychosis and has published widely in this field.
Dr Fiona Lobban is a Senior Lecturer in Clinical Psychology at the Spectrum Centre for Mental Health Research at Lancaster University in the North West of England. She also works as a Consultant Clinical Psychologist supporting family work in the Early Intervention Service for Psychosis in Lancashire care NHS Trust.

Key References:

Barrowclough, C., and Hooley, J., (2003). Attributions and expressed emotion: A review. Clinical Psychology Review, 23, 849-880

Lobban, F., Barrowclough, C., Jones, S. (2003). A review of models of illness in mental health. Clinical Psychology Review, 23, 171-196

Lobban, F., Barrowclough, C., Jones, S. (2006). Does EE need to be understood within a more systemic framework? An examination of discrepancies in appraisals between patients with schizophrenia and their relatives. Social Psychiatry and Psychiatric Epidemiology, 41, 50-55

Lobban, F., Barrowclough, C., Jones, S., (2005). Assessing cognitive representations of mental health problems: II The Illness Perception Questionnaire for Schizophrenia, Relatives' version. British Journal of Clinical Psychology, 44, 163-181.


Workshop 16

Collaborative Case Conceptualisation: Three Principles and Steps for Individualizing Evidence-Based Treatments

Willem Kuyken, University of Exeter and Robert Dudley, Northumberland, Tyne and Wear Mental Health NHS Trust

Case conceptualization is a cornerstone of cognitive-behavioural therapy (CBT) because it tailors evidence-based therapies for clients' unique presentations. Yet many therapists don't use conceptualization systematically or do so uncertain whether they are doing it well. Further, case conceptualization is often taught as an activity that happens in the therapist's head during or between sessions. In this workshop we teach a new approach that we call Collaborative Case Conceptualization. Our model incorporates three key principles: collaborative empiricism, incorporation of client strengths, and levels of conceptualization. Therapist and client work collaboratively to first describe and then explain the issues a client presents in therapy. Rather than simply look at client problems, our model incorporates client strengths to maximize the opportunities not only to relieve client distress but also to build client resilience. In this workshop we will demonstrate this new model of case conceptualization that is constructed collaboratively with clients in session and purposefully incorporates strengths. We also illustrate two levels of case conceptualization: descriptive and explanatory and illustrate how these are co-constructed with the client to help make sense of his or her presenting difficulties, and then are used to aid the selection of targeted treatment strategies that help create meaningful change.

Key Learning Objectives:

  • Methods to help clients understand presenting issues using descriptive and explanatory models of conceptualization
  • How to incorporate client strengths into each phase of conceptualization to set the stage for building resilience
  • The importance of working collaboratively and empirically to develop, test and refine conceptualizations.
  • Participants will gain greater knowledge, skills and confidence in individualising CBT.

Willem Kuyken (Professor of Clinical Psychology) works as a researcher, trainer and clinician at the Mood Disorders Centre in Exeter. A particular theme of his work is exploring how therapists develop, and share conceptualizations to enhance the effectiveness of therapy.
Robert Dudley, is a clinician working with people with psychotic illness. For many of these people making sense of what happened to them, and developing less distressing explanations for their unusual experiences are key clinical tasks. This workshop is based on a book written by Willem and Rob with their co-author Christine Padesky entitled Collaborative Case Conceptualization.

Key References:

Bieling, P. J. & Kuyken, W. (2003). Is cognitive case formulation science or science fiction? Clinical Psychology-Science and Practice, 10, 52-69.

Kuyken, W., Padesky, C.A., Dudley, R. (2009). Collaborative case conceptualization: Working effectively with clients in cognitive behavioural therapy. New York: Guilford Press.


Workshop 17

An Introduction to Compassion-focused Therapy for Shame and Self-Criticism

Paul Gilbert, University of Derby

Shame and self-criticism play key roles in the causation, formation and maintenance of a range of disorders, (anxiety, depression, eating and personality disorders) and avoidance of help-seeking. This workshop explores an evolutionary and safety strategies approach to shame and self-criticism. Participants will learn to distinguish between external shame (thoughts and feelings focused on what one thinks others think about the self) and internal shame (self-focused thoughts and feelings). Key skills include recognising the varied presentations of shame, function analysis of self-critical thinking and use of imagery. The second part of the workshop focuses on a new and innovative approach, called Compassionate Focused Therapy (CFT) and Compassion Mind Training (CMT). CMT focuses on developing care-focused attributed and (e.g., self-care-focused motivation, distress tolerance, empathy/acceptance) and Compassionate skills of compassionate attention, thinking, behaviour, feeling and imagery

Key Learning Objectives:

Participants will develop their understanding of

  1. The different types of shame
  2. The link between shame and self criticism
  3. How to do a functional analysis on self criticism and shame
  4. The evolutionary model of compassion
  5. Some basic compassion focused interventions

Paul Gilbert is Professor of Clinical Psychology at the University of Derby and Director of the Mental Health Research Unit, Derbyshire Mental Health Services NHS Trust. He is a Fellow of the British Psychological Society and a Past President of the British Association For Cognitive and Behaviour Psychotherapy (2003-2004). He has written, taught and researched extensively in the areas of mood disorders and shame. Compassion Focused Therapy is being researched in a range of ways including: treatment, brain scanning, qualitative and quantitative studies with a range of mental health problems

Key References:

Gilbert, P (2007) Psychotherapy and Counselling for Depression. London Sage

Gilbert, P ed (2005). Compassion: Conceptualisation, Research and Use in Psychotherapy. London: Routledge.

Gilbert. P & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: A pilot study of a group therapy approach. Clinical Psychology and Psychotherapy, 13, 353-379

Gilbert P (2007) Overcoming Depression: Audio CD of eight talks for self-help. Available from Amazon.co.uk

Gilbert, P, (2009) The Compassionate Mind: A New Approach to Facing the Challenges of Life: London: Constable Robinson.

Gilbert (in press) An introduction to the Therapy and Practice of Compassion Focused Therapy London: Routledge.

Leary, M.R ., Tate, E.B., Adams, C.E., Allen, A.B., and Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: The implications of treating oneself kindly. Journal of Personality and Social Psychology, 92,887-904

See also

www.compassionatemind.co.uk | www.Self-compassion.org | www.Awarenessinaction.org


Workshop 18

Managing Endings with Complex Cases in Primary and Secondary Care - A Cognitive Behaviour Therapy Approach

Andrew Eagle and Michael Worrell, Central and North West London NHS Foundation Trust

This workshop focuses on the management of the ending phase of therapy in complex clinical cases where personality disorder, interpersonal factors and the wider social and economic context can intersect to create difficult and unproductive endings in therapy. The ending phase of therapy has received relatively little attention in the Cognitive Behavioural literature, but in reality this is a key phase in therapy that requires sensitive and skilled clinical management. Successful therapeutic endings are particularly difficult to achieve in cases where there have been limited clinical gains or patients express dissatisfaction with aspects of the therapy they have received. Many therapy endings do not occur in a planned fashion and patients may prematurely drop out, with associated challenges for therapists' sense of clinical competence. Alternatively, therapists may persevere with unproductive and/or potentially harmful treatments where the goals of treatment are unclear and unrealistic or have not been achieved. Therapy endings are usually more complicated in longer treatments where standard CBT is adapted to meet the needs of a more disturbed client group with limited coping skills and fewer social resources. In these cases, the therapist's own maladaptive schemas may be triggered, resulting in ineffective management of termination.

A number of broader development in the field of CBT have given new impetus to the importance of managing endings well. These include:

Increased emphasis on providing CBT in brief, time-limited formats in services with high demand and patient turnover, increased focus on measurement of clinical outcomes and the active use of these measures to guide decision-making about ending therapy, the application of CBT to an ever-expanding range of complex and/or chronic clinical disorders that may be less likely to respond to treatment e.g., personality disorder, psychosis, an increasingly educated clinical population with high and sometimes unrealistic expectations about the benefits of CBT.

The workshop aims to introduce participants to models of endings that have historically underpinned clinical practice. A CBT approach to ending therapy will be outlined and participants will be encouraged to consider the extent to which this model is consistent with their clinical practice. Emphasis will be given to the beginning phase of therapy, because a CBT approach to endings must of necessity, involve a discussion of treatment planning and treatment goals. Particular attention will be given to the management of difficult or unsatisfactory endings and participants will be given ample opportunity to discuss challenging cases from their clinical practice.

Key Learning Objectives:

  • Learn to more effectively manage complex endings in cases with poor outcomes and/or dissatisfied clients
  • To become aware of the models of endings that are implicitly or explicitly informing their clinical practice
  • Learn about a systematic CBT model of Ending
  • Learn to properly plan therapy to minimise the possibility of unsuccessful endings.
  • Learn to effectively promote patient autonomy and self-efficacy and to minimise the risk of development of unhealthy dependency on therapy.
  • For participants to reflect on their own beliefs and schemas and how these may contribute to ineffective management of the ending process

Dr Andrew Eagle is the Head of an Adult Psychology Service in North West London. He has a long-standing interest in termination issues in psychotherapy, with a particular focus on endings in brief and/or time-limited therapy. He has conducted research in this area using qualitative methodologies.
Dr Michael Worrell is the Course Director for the Royal Holloway/CNWL Post Graduate Diploma in CBT. He has extensive experience of training and consultation in CBT and is currently closely involved in the provision of training for High Intensity Therapists in new IAPT services

Key References:

Davis, D. (2008). Terminating Therapy: A Professional Guide to Ending on a Positive Note. New Jersey: John Wiley.

Goldfried, M. R. (2002). A cognitive-behavioural perspective on termination. Journal of Psychotherapy Integration, 12(3), 364-372.

O'Donohue, W & Cucciare, M. (2008). Terminating Therapy: A Clinician's Guide. New York: Routledge


Workshop 19

The Cognitive Behavioural Therapist's Guide to Low-intensity Cognitive Behaviour Therapy: What Every Therapist Should Know

David Richards, University of Exeter

We have come a long way since the early days when empirically derived CBT techniques were in their infancy, our methods have changed and our thinking has developed, but the idea that 'low intensity' treatment is part of the way we do things persists in the CBT movement's consciousness. In the UK, from 2008 onwards, at least 40% of all CBT therapists will be specifically trained to deliver a low-intensity version of CBT, which must, therefore, be a major component of any CBT service. With low-intensity caseloads four times that of high-intensity

CBT workers, the vast majority of patients are likely to be receiving low-intensity forms of treatment. Clearly it is absolutely essential that all CBT practitioners, high- and low-intensity specialists, have a sound understanding of what low-intensity CBT is all about. This workshop will outline the essential method that is low-intensity CBT. The workshop is suitable for the service user, the experienced, the novice, the supervisor and the service manager alike.

Anyone commissioning, managing, delivering or supervising CBT within new high volume psychological therapies services will benefit from this workshop by developing a key understanding of low-intensity CBT: the form of CBT most patients will receive in the 21st century.

Key Learning Objectives:

Participants will:

  • have an understanding of the essential components of low-intensity CBT
  • understand 'the what, the when, the where and the how' of low-intensity CBT
  • appreciate the essential combination of 'common' and 'specific' factors skills required to deliver effective low-intensity CBT

David Richards is one of the prime movers in national and international efforts to improve access to treatment for those suffering from common emotional distress. He has been at the heart of the UK's Improving Access to Psychological Therapies Programme (IAPT) since its inception, where he led the development of the low-intensity CBT methods pioneered in the Doncaster demonstration site. He has written the UK's national curriculum for low-intensity therapies workers and, with Mark Whyte, the educator and student materials to support the education of low-intensity therapies workers. He runs a multi-centre research team funded by the Medical Research Council and the National Institute for Health Research to test new models of delivering treatment including stepped care and collaborative care. The results of this research programme have been fundamental to the clinical and educational methods used throughout the UK in the Improving Access to Psychological Therapies Programme.

Key References:

Department of Health/Mental Health Programme/Improving Access to Psychological Therapies (2008). Improving Access to Psychological Therapies Implementation Plan: Curriculum for low-intensity therapies workers. London, Department of Health

Richards, D.A. (2009). Low-intensity CBT. In: Mueller,M., Kennerley, H., McManus, F. & Westbrook, D. (eds). The Oxford Guide to Surviving as a CBT Therapist. Oxford, OUP.

Richards, D. and Whyte, M. (2008). Reach Out: National Programme Educator Materials to Support the Delivery of Training for Practitioners Delivering Low Intensity Interventions. London: Rethink


Workshop 21

An introduction to treating PTSD the NICE way

Deborah Lee, University of Reading

NICE guidance recommends Trauma Focused CBT to work with Posttraumatic Stress Disorder. Yet many clinicians are reluctant to work directly with trauma memories. This is in spite of its compelling evidence base and the fact that it is the treatment of choice with most experts in PTSD. The workshop is a ‘how to do trauma focused CBT’ and draws on the clinical models of Ehlers and Clark, Foa et. al., and theoretical models of Brewin et. al., It will cover formulation, reliving and cognitive restructuring of hotspots. Participants will be offered the opportunity to learn how to use reliving to help process trauma memories and discover unhelpful meanings. We will focus on how to work with pre, peri and post-traumatic appraisals and associated emotional responses.

Key references:

Brewin, C. (2001).  A cognitive neuroscience account of PTSD and its treatment.  Behaviour Research and Therapy.  39, 373-393.

Ehlers, A., Clark, D.M., , A., McManus, F., Fennell, M.J.V., Herbert, C. & Mayou, R.A. (2003). A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessment as early interventions for PTSD. Archives of General Psychiatry, 60, 1024-1032.

Ehlers, A., Clark, D.M., McManus, F. & Fennell, M (2005) Cognitive therapy for posttraumatic stress disorder: development and evaluation. Behaviour Research and Therapy. 43, pp 413-431

Foa, E., Hembree, E., Cahill, S.; Rauch, S.; Riggs, D.; Feeny, N; Yadin, E (2005) Randomized trial of prolonged exposure for posttraumatic stress disorder with or without cognitive restructuring: outcome at academic and community clinics Journal of Consulting and Clinical Psychology vol 73 pp 953-964

Lee, D.A. (2006) Case conceptualisation in complex PTSD: integrating theory with practice.  In Tarrier, N. (Eds).  Case Formulation in Cognitive Behaviour Therapy: The treatment of challenging cases. Routledge. London.