WORKSHOPS - 'Understanding and treating the psychopathology of abnormal cognitive experiences'

THURSDAY 12th APRIL


 

Mindfulness for Psychosis - CANCELLED

 


Treating Body Image Problems

David Veale, South London and Maudsley NHS Foundation Trust and King’s College London

Workshop 2 - More information...

Body Image problems relate to disfigurement or perceived defects. Disfigurements from accidents or surgical procedures may lead to significant distress or handicap. Body Dysmorphic Disorder (BDD) is defined as a preoccupation with a perceived defect in one’s appearance, which is not noticeable to others. The preoccupation is associated with a distorted felt body image with many “safety seeking” behaviours such as mirror gazing, skin-picking, ruminating or constant comparing of one’s perceived defect to others. People with disfigurements and BDD use strategies to camouflage and avoid situations and activities. They may have a poor quality of life, are socially isolated and people with BDD are at high risk of committing suicide. Cognitive behaviour therapy and SSRI medications are recommended for treating BDD. CBT can be used for the body image problems in disfigurement and eating disorders. Habit reversal is recommended for skin picking. Disfigurement may require additional modules for dealing with ongoing teasing and unwanted comments.

By the end of the workshop, clinicians will be able apply skills to a range of body image problems and the key learning objectives are:
1. Recognize and diagnose BDD, a body image problem of eating disorders or disfigurement in DSM5 and planned ICD11.
2. Understand a cognitive behavioural model of body image problems and the factors that maintain the symptoms including the function of processes such as comparing self with others; being excessive self-focused; camouflaging one’s appearance; monitoring and avoiding social threats such as shame, rejection and ridicule from others.
3. Use various assessment scales and conduct a functional analysis of cognitive processes and behaviours that are used as safety seeking.
4. Assess and help clients wanting cosmetic procedures
5. Devise strategies for engagement and change with a focus on ceasing ruminating and comparing, dropping of avoidance and safety seeking behaviours; imagery rescripting for aversive memories; habit reversal for skin-picking and role-playing for ongoing teasing.

David Veale is a Consultant Psychiatrist and leads a national outpatient and residential unit service for people with severe treatment refractory Obsessive Compulsive Disorder (OCD) and Body Dysmorphic Disorder (BDD) at the South London and Maudsley Trust and at the Priory Hospital North London. He is a member of the group revising the diagnostic guidelines for ICD11 for OCD and Related Disorders for the World Health Organisation. He was a member of the group that wrote the NICE guidelines on OCD and BDD in 2006 and chaired the NICE Evidence Update on OCD and BDD in 2013. He has authored or co-authored 85 empirically based articles, 6 books, 13 book chapters, and 35 teaching articles or reviews. He is an Honorary Fellow of the British Association of Behavioural and Cognitive Psychotherapies, a Fellow of the British Psychological Society and Fellow of the Royal College of Psychiatrists. He is a Trustee of the national charities, OCD Action and the BDD Foundation. He is a member of the band Bedlam!

References:
Phillips, K (2017) Body Dysmorphic Disorder: Advances in Research and Clinical Practice. Oxford.

Veale, D. & Neziroglu (2010) Body dysmorphic disorder: a treatment manual Wiley: Chichester. http://dx.doi.org/10.1016/j.jocrd.2013.11.005

Veale, D., Willson, R, Clarke, A. (2009) Overcoming Body Image Problems (including BDD). Robinson


Working With Dissociation

Fiona Kennedy, GreenWood Mentors Ltd.

Workshop 3 - More information...

In recent years there has been increasing research into the role of dissociation in psychosis, as well as the development of clinical interventions to treat dissociation.

One of the difficulties has been that those of us with an extensive understanding of dissociation may have a less well developed understanding of psychosis, and vice versa.

This workshop will present a summary of our current knowledge about dissociation from a CBT perspective. It will outline a CBT model of dissociation as a psychological process, which can affect many areas of functioning including perception, experience and personality. Clusters of symptoms affecting memory, consciousness/perception (including hallucinations), somatic/bodily experience and sense of self can result from dissociative processing of information. Such symptoms can play a central role in states of mind diagnosed as psychosis. Evidence suggests that dissociation might represent an important psychological mediator of the well-established relationship between trauma exposure and the core symptoms of psychosis.

The workshop will summarise key research in the area and use case studies to illustrate how to formulate the role of dissociation in psychosis presentations, in particular those involving hallucinations and delusions,

Key learning objectives:
1. Know CBT theories of dissociation
2. Understand the role of dissociation in psychosis
3. Formulate your own case
4. Know how to explain dissociation to clients
5. Use techniques to reduce dissociation and increase treatment effectiveness

Dr. Fiona Kennedy is a Consultant Clinical Psychologist whose interest in dissociation stemmed from working with unusual, difficult to treat clinical problems. She developed a new CBT model of dissociation along with the WDS measurement scale. She co-edited a book on CBT approaches to dissociation and has worked clinically with dissociation for many years. She researches and lectures nationally and internationally on dissociation and other topics.

References:
F. Kennedy, H. Kennerley and D. Pearson (Eds.) (2013). Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation. London; New York, NY: Routledge.

Cole, C L., Newman-Taylor, K. & Kennedy, F. (2016). Dissociation Mediates the Relationship between Childhood Maltreatment and Sub-Clinical Psychosis. Journal of Trauma & Dissociation, DOI: 10.1080/15299732.2016.1172537.

Moskowitz, A. & Corstens, D. (2008). Auditory Hallucinations: Psychotic Symptom or Dissociative Experience? Journal of Psychological Trauma, 6(2-3) 35-63.


Living well with bipolar disorder: Lifespan approaches to assessing and enhancing personal recovery.

Steven H Jones and Elizabeth Tyler, Lancaster University

Workshop 4 - More information...

There is still a strong medical model emphasis in much research in bipolar disorder. In line with this many of the available psychological treatments are based on approaches to educate people about the nature of bipolar disorder and reduce relapse. Although there is evidence that psychoeducation and relapse prevention interventions can be effective, many service users find these approaches fail to address their personal priorities for therapy.  Recovery focused therapy (RfT) is designed to work in collaboration with the client to identify their personal recovery goals giving due consideration to functional, social and work outcomes.  This workshop will highlight new developments in understanding and treating bipolar disorder from a personal recovery perspective.

The workshop will highlight how evidence-based CBT techniques can be applied in an individualised formulation-based approach in bipolar disorder considering the importance of movement towards personal recovery goals. This stands in contrast to many contemporary manualised approaches which presume that relapses into mania and depression are always the primary outcomes. 

The key learning objectives of the workshop will be
1. To be aware of current NICE guidelines for psychological therapy for bipolar disorder and recommendations for further research
2. To be aware of recent research into psychological processes in bipolar disorder including work on positive psychological outcomes
3. To identify key targets in recovery focused therapy for bipolar disorder
4. Learn a range of techniques for improving recovery outcomes in bipolar disorder
5. Consider adaptations to RfT for older adults and future applications of the recovery approach

Steven was a GDG member for the recent update of NICE Clinical Guidelines for Bipolar Disorder and expert lead for Bipolar Disorder for the IAPT SMI project. He has published widely on the psychology and psychological therapy of bipolar disorder include a number of books (Coping with Bipolar Disorder (2003), The Psychology of Bipolar Disorder (2006) and Cognitive Therapy for Bipolar Disorder (2010). He is currently involved in 5 RCTs of novel psychological therapies for bipolar disorder and related conditions as well as actively researching psychological processes associated with risk and resilience.
Elizabeth is a clinical lecturer at the Spectrum Centre with extensive experience as a clinician and academic researchers in bipolar disorder generally and RfT specifically. Her current research is exploring the application of this approach in older adults in a feasibility and acceptability RCT funded as part of an NIHR fellowship.

References
Jones, S. H., Lobban, F., Cooke, A. et al. (2010). Understanding bipolar disorder: Why some people experience extreme mood states and what can help. British Psychological Society: Leicester.

Jones, S. H., Smith, G., Mulligan, L., Lobban, F., Law, H., Dunn, G., Welford, M., Kelly, J., Mulligan, J., Morrison, A. (2014). Recovery focused CBT for individuals with recent onset bipolar disorder: A randomised controlled pilot trial. British Journal of Psychiatry, 206, 58-66.

Tyler, E., Lobban, F., Sutton, C., Depp, C., Laidlaw, K., Johnson, S & Jones, S. (2016). A feasibility randomised controlled trial of recovery focused CBT for older adults with bipolar disorder: Study protocol. BMJ Open, 6:e010590 doi:10.1136/bmjopen-2015-010590.


Cognitive behavioural treatment of OCD: Enhancing the formulation to enhance treatment outcome

Christine Purdon, University of Waterloo, Canada

Workshop 5 - More information...

Exposure with response prevention remains the most effective treatment for Obsessive-compulsive disorder (OCD), but treatment engagement can be challenging particularly when obsessional ideas are held as truths. The traditional cognitive-behavioural model for OCD tends to underemphasize factors such as core beliefs, learning/developmental history, and self-perpetuating mechanisms in compulsions. The CBT model also tends to underspecify the proximal and distal goals of compulsions and the implications for their persistence. The goal of this workshop is to apply an enriched understanding of these factors to case formulation, treatment engagement, and execution of exposure with response prevention.

The key learning objectives are:
1.         Broaden understanding of self-perpetuating mechanisms and proximal/distal goals in the persistence of compulsions; build into case formulation; factor into treatment plan
2.         Broaden understanding of core beliefs in OCD
3.         Broaden repertoire of treatment strategies

Dr. Christine Purdon is a Professor in the Department of Psychology at the University of Waterloo. She has been studying factors in the persistence of OCD for the past two decades, examining thought management strategies as well as the phenomenology and persistence of compulsions. She has co-authored a self-help book on treatment of repugnant obsessions and co-edited a book on OCD treatment, as well as authored or co-authored over 60 research articles and many book chapters. Dr. Purdon’s most recent research examines the expressed goals of compulsions and the impact of how the goal is framed on its persistence

References
Purdon, C., & Chiang, B. (2016). Treatment of obsessive-compulsive disorder. In A. Carr and M. McNulty (Eds.), The Handbook of Adult Clinical Psychology: An Evidence Based Practice Approach (2nd Ed.) (pp. 492-514). Oxford: Routledge.

Radomsky, A.S., Dugas, M.J., Alcolado, G.M., Lavoie, S.L. (2014). When more is less: Doubt, repetition, memory, metamemory, and compulsive checking in OCD. Behaviour Research & Therapy, 59, 30-39.

Doron, G., Kyrios, M., & Moulding, R. (2007). Sensitive domains of self-concept in obsessive  compulsive disorder(OCD): Further evidence for a multidimensional model of OCD. Journal of Anxiety Disorders, 21, 433–444.