WORKSHOPS

Wednesday 20th July

A programme of 22 one-day Workshops will be held on Wednesday 20th July. The workshops will run from 9.30 - 17.00. These workshops offer participants an opportunity to develop practical skills in the assessment and treatment of a range of problems.  Below is a description of each workshop. You can register using the application form included with this programme or on-line. The number of places are limited so early application is advised.

Workshop 1 Treating Adult Psychopathology Through Couple-Based Interventions
Don Baucom, University of North Carolina, USA
Workshop 2 Cognitive Therapy for Post Traumatic Stress Disorder
Anke Ehlers and Nick Grey, Institute of Psychiatry, King's College London
Workshop 3 The STEPPS Programme for Emotional Intensity (Borderline Personality Disorder): An introduction
Renee Harvey, Sussex Partnership NHS Trust
Workshop 4 Cognitive Behavior Therapy in the Treatment and Prevention of Depression
Steve Hollon, Vanderbilt University, USA
Workshop 5

New Thinking in Treatment Resistant Depression: Targeting Emotional Constriction
Thomas Lynch, Southampton University

Workshop 6 Helping People Choose to Change: Focused Cognitive-Behavioural Therapy for Obsessional Problems
Paul M. Salkovskis, University of Bath
Workshop 7 Treating Disgust Across the Disorders
David Veale, Institute of Psychiatry, King's College London
Workshop 8 Cancelled
Workshop 9 Using the Internet to Provide Cognitive Behaviour Therapy
Gerhard Andersson, Linköping University, Linköping and Karolinska Institute, Stockholm, Sweden and Brjánn Ljótsson, Karolinska Institute, Stockholm, Sweden
Workshop 10 Using Imagery in Cognitive Behaviour Therapy: Exploring the New Frontier
Ann Hackmann, Oxford Cognitive Therapy Centre and James Bennett-Levy, University of Sydney, Australia
Workshop 11 Cognitive Behaviour Therapy for Long Term Medical Conditions: Strategies for Effective Care Delivery
Craig White, University of the West of Scotland
Workshop 12 Mindfulness for children and adolescents with ADHD and their parents
Susan Bögels, University of Amsterdam, the Netherlands
Workshop 13 Cancelled
Workshop 14 Understanding, Assessing, and Treating Binge Eating Disorder
Carlos Grilo, Yale University, USA
Workshop 15 Advancing the Low Intensity Cognitive Behaviour Therapy Clinical Method:  Behavioural Experiments
Marie Chellingsworth, University of Nottingham and Paul Farrand, University of Exeter
Workshop 16 Implementing Cognitive Behaviour Therapy Self-Help Resources
Christopher Williams, University of Glasgow and Mark Lau, University of British Columbia, Canada
Workshop 17 Mindfulness-based Interventions for People with Intellectual and Developmental Disabilities: Reducing Psychological Distress and Facilitating Personal Transformation
Nirb Singh, Angela D.A. Singh, Ashvind N. A. Singh, and Judy Singh, American Health and Wellness Institute, Virginia, USA
Workshop 18 Cognitive Behaviour Therapy and ACT for People Facing Chronic Distress: Examples of Interventions with Dementia Caregivers
Andrés Losada, Universidad Rey Juan Carlos, Madrid, Spain and María Márquez-González, Universidad Autónoma de Madrid, Madrid, Spain
Workshop 19 An Introduction to the Latest Developments in Cognitive Behaviour Therapy for Psychosis
Doug Turkington, Newcastle University and Sara Tai, University of Manchester
Workshop 20 Cancelled
Workshop 21 Cognitive Behaviour Therapy in Complex and Comorbid Cases: Looking for Patterns and Developing Treatment-Guiding Hypotheses
Mark Freeston, Newcastle University
Workshop 22 Improving Outcomes for Poorly Responding Clients
Michael Lambert, Brigham Young University, USA

 

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WORKSHOP 1

Treating Adult Psychopathology Through Couple-Based Interventions
Don Baucom, University of North Carolina, USA

Cognitive-behavioral couple therapy has focused primarily on the couple’s relationship with little attention to the two partners as individuals. In contrast, this workshop will focus on developing and using couple-based interventions when one partner is experiencing individual psychopathology, both within healthy and distressed relationships. Three different couple-based approaches will be described including: (a) partner-assisted interventions; (b) disorder-specific interventions, and (c) couple therapy.  The workshop will include in-depth discussion and demonstrations of couple-based interventions for psychopathology, including anxiety disorders, depression, and eating disorders as examples. These interventions involve the integration of empirically supported interventions for individual psychopathology with cognitive-behavioral approaches to working with couples. A primary goal of the workshop is helping clinicians understand how these approaches can be applied in their own practices.

Learning objectives:
During the workshop, participants will:

  • Learn a framework for integrating individual psychopathology and relationship functioning
  • Gain familiarity with couple-based interventions for anxiety disorders, depression, and eating disorders
  • Learn how to develop couple-based interventions that target other forms of individual psychopathology and enhance relationship well-being

Implications for the science and practice of CBT:
A primary goal of the workshop is helping clinicians understand how to integrate empirically supported interventions for individual psychopathology with well established cognitive-behavioral couple therapy principles to treat individual problems and relationship distress in their own practices.

Donald H. Baucom is Richard Simpson Distinguished Professor of Psychology at The University of North Carolina at Chapel Hill.  Since he received his doctorate in clinical psychology in 1976, he has been actively involved in developing and evaluating couple-based interventions from a cognitive-behavioral perspective.  This work has included focusing on interventions for relationally distressed couples, enhancing the relationships of happy couples, preparing couples for marriage, and employing couple-based interventions for couples in which one partner has a psychological or health problem.  He has conducted more couple therapy intervention trials than any other active researcher.  He currently is conducting couple-based treatment interventions for anxiety disorders and eating disorders. In addition to his research in the couple’s area, he and Norman Epstein have published two books on cognitive-behavioral couple therapy.  He has won several teaching awards, and he holds an endowed chair at the University of North Carolina.  He gives frequent workshops to professionals in the United States and other countries.

References:
Epstein, N., & Baucom, D. H. (2002). Enhanced cognitive-behavioral therapy for couples: A contextual approach. Washington, DC: American Psychological Association.
Baucom, D.H., Kirby, J.S., & Kelly, J.T. (2009).  Couple-based interventions to assist partners with psychological and medical problems.  In K. Hahlweg, M. Grawe, & D. H. Baucom (Eds.), Enhancing couples: The shape of couple therapy to come (pp. 79- 93). Göttingen: Hogrefe.

WORKSHOP 2

Cognitive Therapy for Post Traumatic Stress Disorder
Anke Ehlers and Nick Grey, Institute of Psychiatry, King's College London

Trauma-focused cognitive behavioural treatments have been recommended as treatments of choice in the treatment of posttraumatic stress disorder (e.g., NICE, 2005). Cognitive Therapy for PTSD is a version of these treatments that builds on Ehlers and Clark’s (2000) cognitive model of PTSD. This model suggests that people with PTSD perceive a serious current threat that has two sources, excessively negative appraisals (personal meanings) of the trauma and / or its sequelae and characteristics of trauma memories that lead to reexperiencing symptoms. The problem is maintained by cognitive strategies (such as thought suppression, rumination, safety-seeking behaviours) that are intended to reduce the sense of current threat, but maintain the problem by preventing change in the appraisals and trauma memory, and / or lead to increases in symptoms. Cognitive Therapy for PTSD has been shown to be highly effective and acceptable to patients (Duffy et al., 2007; Ehlers et al. 2003, 2005, 2010a,b; Gillespie et al., 2002; Smith et al., 2007). It has three goals. First, the idiosyncratic personal meanings are identified and changed. Therapeutic techniques include identification of hot spots during the trauma and associated meanings, socratic questioning, and behavioural experiments. Second, the trauma memory is elaborated.  Idiosyncratic personal meanings of the trauma are updated with information that corrects impressions and predictions at the time, using a range of techniques. In stimulus discrimination training, the patient learns to discriminate triggers of reexperiencing symptoms from the stimuli that were present during the trauma. Third, the patient experiments with dropping maintaining behaviours.

Learning objectives:
By the end of the workshop, participants should be able to:

  • Identify key processes in maintaining PTSD
  • Develop an idiosyncratic version of the cognitive model with their patients and
  • Be able to identify appropriate therapeutic techniques.

Implications for the science and practice of CBT:
PTSD is a common disorder in clinical practice. The workshop will introduce participants to an effective way of conceptualizing and treating this problem.

Anke Ehlers is Professor of Experimental Psychopathology and Wellcome Trust Principal Research Fellow at King's College London. She is research director of the Centre for Anxiety and Trauma, Maudsley Hospital. Her research focuses on anxiety disorders. Nick Grey is Consultant Clinical Psychologist and Clinical Director of the Centre for Anxiety and Trauma, Maudsley Hospital. He specializes in anxiety disorders.

References:
Ehlers, A., & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345.
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for PTSD: Development and evaluation. Behaviour Research and Therapy, 43, 413-431.
Grey, N. (2009) (Ed.), A clinical casebook of cognitive therapy for traumatic stress reactions. Hove, UK: Routledge.

WORKSHOP 3

The STEPPS Programme for Emotional Intensity (Borderline Personality Disorder): An Introduction
Renee Harvey, Sussex Partnership NHS trust

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group programme for people with borderline personality disorder (renamed ‘emotional intensity disorder’).  It was developed around 15 years ago by Blum and colleagues in the USA and has been disseminated worldwide.  It is CBT and Schema Therapy based, with a significant systemic component, and is described as ‘value added’ to treatment-as-usual and other forms of psychological therapy for this client group.  It runs for 20 weeks, 2 hours per session.  A significant research data base is developing, including a recent pilot study in Sussex and planned RCT.  STEPPS was introduced into the UK in 2006/7 and groups are now being run in Kent, Surrey and Sussex, with interest growing in other areas.  Around 25 groups have now run in Sussex with a high degree of success and enthusiasm from both clients and clinicians.  The follow-up programme, STAIRWAYS, has also been running for over a year.  A PD Tier 3 intensive day service with STEPPS at the heart has recently opened in Sussex for those with very complex needs, with very significant direct involvement of service user volunteers.  This workshop aims to share some of this experience, and to share some of the challenges and advantages around implementing what is proving to be a cost-effective,  popular and accessible way to meet an important need of a large section of individuals using services.

Learning objectives:

  • An opportunity to reflect with others on key challenges in working with this client group, both intra- and interpersonally and in the system.
  • Working with issues around labelling, challenging stigma and promoting a positive and hopeful attitude.
  • Introduction to STEPPS: what it is and how it relates to the wider treatment context.
  • Assessing, screening and supporting clients to maximise learning and minimise non-completion of groups.
  • Developing service user ‘graduate’ involvement and supporting their further learning and development.
  • Managing risk

Implications for the science and practice of CBT:
STEPPS is highly accessible to anyone with training in CBT.  It is relatively inexpensive, easy to learn and to implement within everyday settings.  The programme is manualised and clearly structured.  When led by a person well trained in CBT, it can be co-presented with colleagues from any clinical discipline as well as providing opportunity for involvement of service user ‘graduates’ in assisting and reinforcing skills learning.

Renee’s role in working for Sussex Partnership Trust is leading on service development and training for people with complex needs (‘personality disorder’).  For the past five years a significant amount of time has been dedicated to establishing STEPPS within Sussex, but she also teaches and presents more widely on personality disorder generally, and STEPPS in particular, locally, nationally and internationally.

References:
Black, D.W., Blum, N. et al. (2004) The STEPPS Group Treatment Program for Outpatients with Borderline Personality Disorder.  Journal of Contemporary Psychotherapy, 34, 193-210.
Blum, N., St.John, D, et al. (2008) Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder. A randomized controlled trial and 1-year follow-up.  American Journal of Psychiatry, 165, 468-478.
Harvey, R., Black, D.W. & Blum, N. (2010) Systems Training for Emotional Predictability and Problem Solving (STEPPS) in the United Kingdom: A Preliminary Report. Journal of Contemporary Psychotherapy, 40(4), 225+.

WORKSHOP 4

Cognitive Behavior Therapy in the Treatment and Prevention of Depression
Steve Hollon, Vanderbilt University, USA

Cognitive therapy when competently implemented has been found to be as efficacious as and more enduring than antidepressant medications in the treatment of depression. Cognitive therapy also appears to reduce risk for serious adverse events including suicide and to be more cost effective over the long-run. This workshop will focus on strategies for maximimizing the enduring effects of cognitive therapy and dealing with more complex and complicated patients.

Learning objectives:

  • To identify the key cognitive and behavioral strategies for working with relatively straight-forward depressed patients and more complex patients with histories of characterological disorders and to extend its enduring effects over time.

Implications for the science and practice of CBT:
The principles and strategies presented during the workshop should translate directly into clinical practice in CBT.

Professor Hollon is an experienced cognitive therapy and an active treatment outcome researcher who has conducted a number of trials of cognitive and behavior therapy. Professor Hollon took his doctorate at the Florida State University before completing his internship and a post-doctoral year at the University of Pennsylvania with Aaron Beck the founder of cognitive therapy. He was a study therapist in the original study by Rush and colleagues that established cognitive therapy as a viable intervention and recently completed a trial with DeRubeis that found cognitive therapy as efficacious as medications and superior to pill-placebo with more severely depressed patients. He has been a leader in establishing that cognitive therapy has an enduring effect that lasts beyond the end of treatment.

References:
DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., O’Reardon, J. P., Lovett, M. L., Gladis, M. M., Brown, L. L. Ph.D., & Gallop, R. (2005). Cognitive therapy vs. medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409-416.
Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L., Freeman, B. B., & Gallop, R. (2005). Prevention of relapse following cognitive therapy versus medications in moderate to severe depression. Archives of General Psychiatry, 62, 417-422.

WORKSHOP 5

New Thinking in Treatment Resistant Depression: Targeting Emotional Constriction
Thomas Lynch, Southampton University

An estimated 40-60% of unipolar depressed patients meet criteria for comorbid personality disorder (PD), with even higher rates among those with chronic or treatment resistant depression (TRD). The most common PDs among depressed individuals are Cluster-A (paranoid PD) and Cluster C (obsessive-compulsive and avoidant PD) precisely those that respond less favourably to evidenced-based depression treatments. Developmental research shows that emotionally constricted, risk averse, and over-controlled children are more likely to develop into depressed and socially isolated adults. Compared with non-chronic major depressive disorder (MDD), chronically depressed individuals show greater self-criticism, impaired autonomy, rigid internalized expectations, excessive control of spontaneous emotion, and inordinate fears of making mistakes and chronically depressed are rated more hostile and less friendly than the acutely depressed.  Research shows higher rates of suicidal ideation and behaviour in TRD; e.g., one study showed that 29% of TRD attempted suicide during the acute phase compared with only 3% of non-chronic patients. Based in part on findings from three pilot randomized controlled trials of dialectical behaviour therapy for TRD; this workshop will outline new approaches that target common problems in TRD and chronic depression, including over-control, rigidity, interpersonal aloofness, emotion inhibition and perfectionism. Unlike standard DBT, developed primarily for use with dramatic-erratic, under-controlled and impulsive disorders (e.g. BPD); this new adaptation is informed by a biosocial theory that posits a biological predisposition to heightened threat sensitivity and diminished reward sensitivity, coupled with childhood invalidation emphasizing that mistakes are intolerable and that the child is special or should be better compared to their peers; results in an over-controlled coping style that limits opportunities to learn new skills and exploit positive social reinforcers. This workshop will review the major treatment adaptations of this new approach using role play and videotape case illustrations.

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 approaches for working with emotionally constricted and risk-averse personality disorders.
  • Participants will learn loving-kindness forgiveness interventions and other methods designed to alter neuro-regulatory responses by directly activating its antagonistic system; i.e., to turn off defensive emotional arousal by activating the parasympathetic nervous system.

Implications for the science and practice of CBT:
The new developments outlined in the workshop can help inform standard CBT approaches for treatment of chronic and treatment resistant forms of depression; as well as provide insight into new ways of understanding how the neuroregulatory system influences behaviour.  

Thomas R. Lynch is a Professor of Clinical Psychology in the School of Psychology at Southampton University. He a world-leading researcher and senior trainer of dialectical behaviour therapy (DBT) and directs a biobehavioural laboratory focused on understanding personality/mood disorders and their interface with basis emotion processes. He has received multiple large research grants from a range of sources, including the National Institutes of Health, NARSAD—National Alliance for Research on Schizophrenia and Depression, American Foundation of Suicide Prevention, and the Hartford Foundation. He is a recipient of the John M. Rhoades Psychotherapy Research Endowment and a Beck Institute Scholar. His book outlining a new DBT adaptation, entitled Dialectical Behaviour Therapy for Treatment Resistant Depression; Targeting Emotional Over-Control is forthcoming.

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. (2008). Dialectical behavior therapy for co-morbid personality disorders. Journal of Clinical Psychology, 64, 1- 14.
Lynch, T. R. & Cuper, P. (in press).  Dialectical Behaviour Therapy of Borderline and Other Personality Disorders. Oxford Handbook of Personality Disorders; Oxford Press.

WORKSHOP 6

Helping People Choose to Change: Focused Cognitive-Behavioural Therapy for Obsessional Problems
Paul M. Salkovskis, University of Bath

Cognitive-behavioural theory indicates that anxiety is related to the perception of threat or impending danger to oneself and/or others. Obsessive-compulsive disorder results when people misinterpret intrusive thoughts as a sign not only that harm may occur, but that they may be responsible for it through what they do or fail to do. People thus develop obsessional problems because they interpret normal intrusive thoughts as a sign that they may be responsible for harm if they fail to take preventative action. The preventative action (compulsive behaviour) is motivated by the way in which the person interprets intrusions as indicating that they may be responsible for harm to themselves or other people. However, the reactions which are motivated in this way can and do have two effects. Firstly, they can increase the occurrence of intrusive cognitions and secondly, maintain or even increase the person’s beliefs about threat and their responsibility for it. The cognitive-behavioural treatment that has been developed from this theory has several components, but one primary focus.  Therapy seeks to help the patient understand their problem as one of anxiety rather than danger and to react accordingly.

Learning objectives:
In this workshop a multi-stage treatment will be described with the main focus being on providing practical clinical details of cognitive-behavioural treatment as applied to obsessional problems. This training workshop will describe and demonstrate clinical strategies which allow the application of a personalised combination of the following components and stages in each patient:

  • Helping the person to identify the intrusions, the way these are interpreted and the specific vicious circles involved in the maintenance of both. The aim of this aspect of treatment is to give the person a new (and less frightening) way of thinking about their problem and what they can do about it. Subsequent treatment components draw upon and build up this re-conceptualisation of their obsessional problem. This is a crucial stage as the remainder of therapy is driven by this therapeutic conceptualisation. Strategies to normalise the experience of intrusions and help the person to interpret them in a less threatening way, so that they are better able to react less or not at all to them. Strategies which modify both (a) the general beliefs which lead the person to misinterpret intrusions (e.g. “thinking something is as bad as doing it”) and (b) the specific interpretations (e.g. “I had the thought I hoped my mother would die; this means I want to kill her”) which arise from the general beliefs and motivate the counter-productive reactions.
  • Techniques designed to normalise the experience of intrusions and help the person to see that they do not need to engage in compulsive behaviour.
  • Helping the person to devise, carry out and make sense of behavioural experiments with which they can test the accuracy of their new way of thinking about their problem.
  • Helping the person to understand the counter-productive effects of safety seeking behaviours, particularly overt and covert compulsions. This allows therapist and patient to negotiate a programme of exposure to feared stimuli combined with prevention of compulsive behaviours. This programme is tailored in ways which help the person discover (a) that their anxiety can and will be reduced without resorting to compulsive behaviours and (b) where appropriate, that the consequences they fear were not being prevented by the compulsions. Although similar to exposure and response prevention, the emphasis is quite different and specific cognitive strategies (e.g. the use of metaphor) are used to achieve the required results.
  • Helping the person to re-establish important non-obsessional aspects of their life (their social life, education, occupational issues and so on).
  • Identify relapse prevention strategies, and anticipate how these could best be activated if the person were to find their problem recurring.
  • The importance of treatment flexibility and integrity will be emphasised; detailed supervision is the best strategy to ensure these.

Implications for the science and practice of CBT:
The workshop will incorporate details of a range of new developments, and how these can be applied in clinical practice using standard and intensive treatment.

Paul Salkovskis is Professor of Clinical Psychology and Applied Science and the Programme Director on the new Clinical Psychology Doctorate Programme at University of Bath since September 2010, and prior to this was based at the Institute of Psychiatry, King’s College, London since October 2000 and Clinical Director at the Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Trust from the same date. His research interests have focused on the importance of distorted thinking in the understanding of emotional disorders, and on ways of modifying such negative thinking in order to change problematic behaviours and control negative emotional reactions.

References:
Salkovskis, P. M., E. Forrester, et al. (1998). The devil is in the detail: conceptualising and treating obsessional problems. Cognitive therapy with complex cases. N. Tarrier, Wells, A., Haddock, G. (eds). Chichester, Wiley.
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, p29-p52.
Salkovskis, P. M. and Wahl, K., 2003. Treating obsessional problems using cognitive-behavioural therapy. In: Reinecke, M. and Clark, D. A., eds. Cognitive Therapy Across the Lifespan: Evidence and Practice. Cambridge: Cambridge University Press, pp. 138-171.
Salkovskis, P. M., 2007. Psychological treatment of obsessive-compulsive disorder. Psychiatry, 6 (6), pp. 229-233.

WORKSHOP 7

Treating Disgust across the Disorders
David Veale, Institute of Psychiatry, King's College London

Disgust is a core emotion and it’s derivatives such as self-disgust (shame and contempt) has been neglected area in research.  Disgust is associated with phobic avoidance but standard exposure is less effective for disgust than for anxiety. Furthermore beliefs associated with disgust are often inaccessible. Disgust elicitors include eating/food; excreting; sex and death but there is also inter-personal disgust and moral disgust. We will focus on the treatment of four problems that have a large component of disgust or self-disgust, namely fears of contamination and moral contamination in obsessive-compulsive disorder, body dysmorphic disorder, fears of death and a specific phobia of vomiting.

Learning objectives:
By the end of the workshop, participants will 

  • Be knowledgeable about the emotion of disgust and derivatives such as self-disgust (shame) and it’s measurement
  • Assess and treat a Specific Phobia of Vomiting
  • Assess and treat a fear of death 
  • Assess and treat fears of physical and moral contamination in OCD 
  • Assess and treat Body Dysmorphic Disorder

Implications for the science and practice of CBT:
This is a practical workshop through which participants will develop confidence in treating disgust across three common and not so common disorders.

David Veale is Consultant Psychiatrist in Cognitive Behaviour Therapy at the South London and Maudsley Trust and Hon Senior Lecturer at Institute of Psychiatry, King’s College London. He provides a national outpatient and residential service for severe anxiety disorders.  He has published about 70 peer-reviewed articles (mainly in OCD and BDD) and four self-help books. He was a member of the group that produced NICE guidelines on OCD & BDD. He is a former President of the BABCP.

References:
Olatunji, B.O, Mckay, D.(2008)  Disgust and Its Disorders: Theory, Assessment, and Treatment Implications. American Psychological Association:
Rachman, S. (2006) The Fear of Contamination: Assessment and treatment. Oxford University Press
Veale, D (2009) Treating a Specific Phobia of Vomiting. The Cognitive Behaviour Therapist, 2, 272–288.
Veale, D, Neziroglu, F, (2010) Body Dysmorphic Disorder: a treatment manual. Wiley, Chichester.

WORKSHOP 8

Cancelled

WORKSHOP 9

Using the Internet to Provide Cognitive Behaviour Therapy
Gerhard Andersson, Linköping University, Linköping and Karolinska Institute, Stockholm, Sweden and Brjánn Ljótsson, Karolinska Institute, Stockholm, Sweden

Guided Internet-delivered CBT has been tested in well over 30 randomized controlled trials and in some studies comparisons with face-to-face CBT indicate that the two treatment formats can perform equally well. It is clear from the literature that pure self-help treatments without guidance are less effective, but on the other hand these treatments may serve as a first step in a stepped care process. However, guided Internet-delivered CBT can be suitable not only as a first step but as an alternative to individual or group-based CBT. Among the advantages of guided Internet-delivered CBT are cost-effectiveness, convenience, and that it saves therapist time.

Learning objectives:

  • Understanding the varieties of Internet treatments and their differential effects
  • Getting to know what is needed to set up a service using the Internet (the basics)
  • Learning what is required to obtain good outcomes with guided Internet treatment. Knowing what is required in terms of therapist training and skills.
  • Learning about the pros and cons of Internet treatment including tailoring treatment according to patient symptom profile.

This workshop is aimed at clinicians and researchers with a background in CBT, and an interest in guided self-help and the use of the Internet as a complement to regular CBT.

Implications for the science and practice of CBT:
Most CBT clinicans are already required to handle modern information technology, including the Internet and mobile phones, in their regular treatments. The increasingly strong support for guided Internet treatment will inform clinical practice and it is very likely that online services will be integrated with face-to-face CBT in the very near future. This may be in the form of a complement but also as a replacement facilitating the dissemination of CBT in a stepped care approach.

Gerhard Andersson is professor in clinical psychology and has developed evidence-based Internet treatments for various conditions such as depression and anxiety disorders (www.gerhardandersson.se). Brjánn Ljótsson is clinical psychologist and researcher with a focus on the treatment of irritable bowel syndrome. In addition, he has been responsible for the programming of a full Internet treatment service currrently running as regular treatment at the Internet psychiatry unit in Stockholm, Sweden.

References:
Andersson, G. (2009). Using the internet to provide cognitive behaviour therapy. Behaviour Research and Therapy, 47, 175-180.
Andersson, G. (2010). The promise and pitfalls of the Internet for cognitive behavioural therapy. BMC Medicine, 8:82.
Ljótsson, B., Falk, L., Wibron Vesterlund, A., Hedman, E., Lindfors, P.-J., Rück, C., Andersson, G. (2010). Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome--a randomized controlled trial. Behaviour Research and Therapy, 48, 531-539.

WORKSHOP 10

Using Imagery in Cognitive Behaviour Therapy: Exploring the new frontier
Ann Hackmann, Oxford Cognitive Therapy Centre and James Bennett-Levy, University of Sydney, Australia

Integrating imagery effectively into clinical practice is one of the newest and most exciting frontiers in CBT. Negative intrusive imagery is common in psychopathology, and there is a growing body of evidence to support the use of imagery-based interventions in CBT. This new evidence comes from laboratory studies, and various treatment studies. At this stage, clinicians may be aware of the potential power of working with imagery, but remain uncertain of efficacious methods to harness this safely. Based on their new book, The Oxford Guide to Imagery in Cognitive Therapy (Hackmann, Bennett-Levy & Holmes, 2011), the workshop leaders will provide a roadmap to the use of imagery in CBT practice, and give participants plenty of opportunity both to see the skills modelled, and to hone their own skills.  The workshop will cover the key methods currently available for working with imagery, with a special emphasis on providing an update on potential new applications in a variety of disorders, including PTSD, social phobia, OCD, BDD, depression, suicidality and bipolar disorder. New work on creating healthy positive imagery will also be presented, and there will also be a section on working with client metaphors and symbolic imagery.

Learning objectives:
Participants can expect to leave with:

  • An enhanced understanding of the value and uses of imagery in psychopathology
  • Some helpful frameworks within which to conceptualise imagery-based interventions
  • New skills to implement image-based interventions in a range of clinical situations with different disorders
  • Enhanced confidence around the use of imagery, leading to greater utilisation in clinical practice

Implications for the science and practice of CBT:
The workshop will provide participants with the conceptual understanding, skills and confidence to enhance their effective use of imagery in everyday clinical practice.

Ann Hackmann has been a leading clinical researcher on imagery over the past 15 years. Over the last 5 years, she has collaborated with James Bennett-Levy and Emily Holmes to write the Oxford Guide to Imagery in Cognitive Therapy (2011). The aim of this project has been to provide clinicians with a useful handbook, which charts recent advances in experimental and clinical research on imagery and provides a ready-made guide to imagery-based interventions. Previously James and Ann co-edited (with Butler, Fennell, Mueller and Westbrook) the valuable clinical text, the Oxford Guide to Behavioural Experiments in Cognitive Therapy (2004).

References:
Arntz, A. and Holmes, E.A. (2007) Special Issue on imagery rescripting.
Journal of Behavior Therapy and Experimental Psychiatry, 38, (4).
Hackmann, A., Bennett-Levy, J. & Holmes, E.A. (2011).  The Oxford guide to imagery in cognitive therapy.  Oxford University Press, Oxford.
Holmes, E.A. & Hackmann, A. (eds.) (2004). Special issue on mental imagery and memory in psychopathology. Memory, 12 (4).

WORKSHOP 11

Cognitive Behaviour Therapy for Long Term Medical Conditions: Strategies for Effective Care Delivery
Craig White, University of the West of Scotland

CBT now has an established role in the management of a range of disorders commonly presenting in adult mental health care settings.  These disorders are common among people with long term medical conditions and are beginning to be subject to meta-analyses and reviews of effectiveness.  Clinicians are often required to balance the integrity of evidence based treatment protocols when there is an absence of similar protocols addressing the complexities of specific challenges of working with the physically ill.  This workshop focuses on how to maximise adherence to established CBT practice that also integrates evidence based findings from clinical health psychology and emergent findings from CBT tailored to specific care populations.  It will also outline some of the challenges and tactics that can be applied in ensuring that benefits of CBT for this clinical population are maximised through effective leadership, engagement and strategic planning.

Learning objectives:
This workshop will enable participants to:

  • Explore how health psychology concepts and findings can be integrated within CBT practice for physical health problems
  • Consider common cognitive behavioural therapeutic processes across problems that are encountered in key medical sub-specialties
  • Apply health psychology findings and approaches using established CBT frameworks, protocols and approaches to healthcare delivery.

Implications for the science and practice of CBT:
This workshop will enable CBT practitioners increase their knowledge, skills and confidence in tailoring their approaches to the needs of people with long term physical health problems.  It is most suited for those with established competence of delivery for common adult mental health problems and those wishing to increase familiarity with approaches to delivering CBT protocols for common physical health presentations, tailoring CBT approaches and translating clinical health psychology findings to support relevant assessment and formulation.

Craig White trained as a clinical psychologist at the University of Manchester, qualifying in 1995.  His research interests have related to the role of cognition in conceptualising adjustment to illness – including changed appearance as a result of surgical treatment for colorectal and urinary symptoms and cancer. He returned to NHS practice in 2002 to develop a psychosocial oncology service that included a team of clinical nurse specialists trained to deliver cognitive behavioural assessment and intervention strategies. He left this in 2007.  In recent years, he has moved to various senior management positions within the NHS, working currently as Assistant Director for Healthcare Quality and Governance and the Caldicott Guardian in NHS Ayrshire and Arran.  He works on a sessional basis as Professor of Psychological Therapies at the University of the West of Scotland, where doctoral students are researching the role of formulation and supervision in efficacy of cognitive therapy.  He retains a small clinical practice mostly focused on CBT of adult mental and physical health problems and is currently updating his 2001 book ‘Cognitive Behaviour Therapy for Long Term Medical Conditions’ for a the publication of the Second Edition.

References:
White (2001). Cognitive Behaviour Therapy for Chronic Medical Problems.  Chichester: John Wiley & Sons. ISBN 0471494828
Sensky, T. (2004). Cognitive Behavior Therapy for Patients with Physical Illnesses. in Wright, JH. Cognitive-Behavior Therapy. Vol 23. Review of Psychiatry. American Psychiatric Press.  ISBN 1585621781
Halford, J & Brown, T. (2009). Cognitive-behavioural therapy as an adjunctive treatment in chronic physical illness. Advances in Psychiatric Treatment, 25, 306-317.

WORKSHOP 12

Mindfulness for children and adolescents with ADHD and their parents
Susan Bögels, University of Amsterdam, Netherlands

Children with ADHD [Attention Deficit Hyperactivity Disorder] have problems maintaining attention over prolonged periods of time, have difficulty holding goals and plans in mind, and have difficulty inhibiting a pre-potent response. Mindfulness training is an intervention based on eastern attention/meditation techniques that helps increase a wide, open awareness as well as focused attention, and reduces automatic responding. 

In this workshop, the rationale, program details, and effects of an 8-session mindfulness group training for children and for adolescents with ADHD, and a parallel mindful parenting group training for their parents, will be discussed. 

Mindfulness exercises that we have found to be helpful for children and for adolescents with ADHD can be experienced in the workshop (with the participants being children or adolescents for that purpose) and will be demonstrated with video-fragments of real training sessions. Also, exercises from the mindful parenting program will be demonstrated. Results of scientific research on the immediate and follow-up effects of the training on children as well as parents' ADHD symptoms, as well as on other measures, such as parental stress and parental reactivity, will also be presented.  

Key learning objectives:
-Insight in the type of attention problems of children with ADHD, and how mindfulness may influence these problems
-Knowledge of the scientific results of mindfulness training for children with ADHD and their parents, also in comparison to other treatment options
-Knowledge about the similarities and differences of this program compared to MBCT/MBSR programs for adults with depression, pain, etc.
-Experiencing mindfulness practice from the perspective of a child or adolescent with ADHD and their parents
-Orientation on the skills needed for mindfulness teachers working with this population: group management skills, mindfulness skills for working with children, mindful parenting skills

About the workshop leader:
Susan Bögels is professor of developmental Psychopathology at the University of Amsterdam (UvA), and director of the UvA Treatment Center for Parents and Children.  She has been studying mindfulness in different contexts, such as for patients with social anxiety disorder, for adolescents with externalizing disorders, for parents in mental health care settings, for children with ADHD, and for children in school settings, together with her research and clinical team. She has published theoretical as well as research papers about mindfulness, and is currently writing a book for professionals on Mindful Parenting.

References:
Oord, S. van der, Bögels, S.M., & Peijnenburg, D. (2011 online). The effectiveness of mindfulness training for children with ADHD and mindful parenting for their parents. Mindfulness.
Bögels, S.M., Lehtonen, A., & Restifo, K. (2010) Mindful parenting in mental health care. Mindfulness, 1, 107-120.

WORKSHOP 13

Cancelled

WORKSHOP 14

Understanding, Assessing, and Treating Binge Eating Disorder
Carlos Grilo, Yale University, USA

Binge eating disorder (BED) is characterized by recurrent binge eating accompanied by feelings of loss of control and marked distress in the absence of inappropriate weight compensatory behaviours. BED, the most prevalent eating disorder diagnosis, is strongly associated with obesity and with elevated risk for medical and psychiatric co-morbidity and psychosocial impairment (Hudson et al., 2007).  These co-morbidities, particularly the strong association with obesity and associated metabolic problems, make BED a challenging clinical problem. Cognitive behavioral therapy (CBT) is the best established treatment but it does not produce weight loss and some evidence supports the effectiveness of behavioral weight loss (BWL) therapy although the findings are mixed. Combining pharmacotherapy with psychosocial interventions fails to significantly enhance binge eating outcomes although some findings suggest specific medications may enhance weight losses achieved with CBT and BWL treatments.  Emerging research on predictors and moderators of treatments outcomes has clinical implications for treatment delivery and for stepped-care treatment models for obese patients with BED. An improved clinical understanding of the nature of the core and associated features of BED will facilitate the clinician’s ability to select and implement evidence-based interventions. An improved clinical understanding of the co-morbidity of BED with obesity, including weight loss challenges, metabolic problems, multidimensional aspects of body image, and stigma, will facilitate the clinician’s ability to effectively deliver CBT and BWL methods.

Learning objectives:
By the end of the workshop, participants should be able to:

  • Understand the nature and significance of the core features of binge eating disorder and associated features including eating disorder psychopathology, psychological functioning, obesity, and co-morbid psychiatric and medical disorders.
  • Recognize major assessment and diagnostic issues and methods
  • Identify and understand evidence-based treatment options, including psychological, pharmacological, and combination approaches.
  • Implement individual, group, and guided-self-help versions of cognitive behavioural therapy (CBT), which is the best-established treatment for binge eating disorder, and behavioural weight loss therapy to address co-existing obesity.

Implications for the science and practice of CBT:
CBT and BWL are evidence-based manualized approaches for treating BED and associated obesity. Even the best available treatments do not work for a substantial minority of patients and findings ways to enhance weight loss outcomes remains a pressing clinical challenge. An improved understanding of the nature of BED will facilitate the delivery of effective treatments. An improved understanding of predictors and moderators of treatment may facilitate treatment selection and inform stepped-care approaches.

Carlos M. Grilo, Ph.D. is Professor of Psychiatry and Director of the Program for Obesity, Weight, and Eating Research at the Yale University School of Medicine. Dr. Grilo is also Professor of Psychology at Yale University where he is an affiliate of the Rudd Center for Food Policy and Obesity. Dr. Grilo received a Sc.B. in psychology from Brown University, a Ph.D. in clinical psychology from the University of Pittsburgh, completed an internship and a fellowship at Harvard Medical School, and completed postdoctoral training at Yale University, Dr. Grilo then joined the faculty at Yale University School of Medicine and served as Director of Psychology at the Yale Psychiatric Institute until 2000. Dr. Grilo’s primary research focus is on eating disorders and obesity and his secondary interests include personality disorders and psychopathology.  Dr. Grilo has been the recipient of numerous research grants and has served as Principal Investigator on eight grants from the National Institutes of Health including two K24 Mid-Career Investigator Awards in Eating and Weight Disorders to support his research and mentoring activities.  Dr. Grilo currently serves on the editorial boards of seven professional journals and has published over 280 peer-reviewed journal articles.

References:
Grilo, C.M. & Mitchell, J.E. (editors) (2010). The Treatment of Eating Disorders: A Clinical Handbook.  New York:  Guilford Press.
Wilson, G.T., Grilo, C.M., & Vitousek, K.M. (2007).  Psychological treatments of eating disorders.  American Psychologist, 62, 199-216.
Wilson, G.T., Wilfley, D.E., Agras, W.S., & Bryson, S.W. (2010).  Psychological treatments of binge eating disorder. Archives of General Psychiatry, 67, 94-101.

WORKSHOP 15

Advancing the Low Intensity Cognitive Behaviour Therapy Clinical Method:  Behavioural Experiments
Marie Chellingsworth, University of Nottingham and Paul Farrand, University of Exeter

Behavioural experiments are planned experiential activities based on the patient’s active experimentation or observation. The primary purpose is for the patient to obtain new information to test the validity of existing beliefs and construct and/or test new, more adaptive beliefs (James Bennett-Levy et al, 2004). Behavioural experiments have been effectively used across disorders in Cognitive Behavioural Therapy (CBT) for many years.  However, despite cognitive restructuring being a key intervention in the Psychological Wellbeing Practitioners (PWP) role, the use of behavioural experiments has not featured in Low Intensity CBT.  If adapted to be consistent with Low Intensity CBT methodology, behavioural experiments could play a significant role in the Low Intensity clinical method. This adaptation would extend the ‘tool-kit’ of behavioural interventions in the clinical methods and provide a structured and formal way in which Psychological Wellbeing Practitioners can support patients to test any restructured thoughts by putting them into practice and thereby extend and enhance low intensity cognitive restructuring.

Learning objectives:
The workshop will enable participants to:

  • Demonstrate knowledge of what behavioural experiments are and what contribution they make in Cognitive Behavioural Therapy
  • Consider how behavioural experiments have been used in clinical practice across a range of disorders in CBT
  • Demonstrate knowledge of and competence in understanding how to adapt the design and implementation of behavioural experiments in Low Intensity CBT clinical methods in depression and anxiety disorders
  • Demonstrate awareness of when and how to use behavioural experiments in Low Intensity CBT and how these can be supported within the PWP role and delivery methods
  • Consider how to implement and support PWP’s use of behavioural experiments as part of Low Intensity Education and Supervision
  • Practice the use of behavioural experiments and their design both within the session, and utilising Self Practice and Self Reflection (SP/SR) methods to consolidate learning after the workshop

Implications for the science and practice of CBT:
The workshop is a key learning and continuing professional development opportunity for Psychological Wellbeing Practitioners, Low Intensity Case and Clinical Supervisors and PWP Educators and Course Leaders. Widening and advancing the PWP Clinical methods to include behavioural experiments will extend and enhance the behavioural intervention skill set of the Psychological Wellbeing Practitioner in delivering cognitive restructuring with patients.

Marie Chellingsworth is the IAPT Course Director at The University of Nottingham and leads the accredited Low Intensity Training Programme. She has contributed to the IAPT Reach Out Supervisor Manual and The Oxford Guide to Low Intensity Interventions. Marie chairs the PWP Special Interest group and is a committee member of the PWP accreditation panel.   
Dr Paul Farrand is Low Intensity Clinical Teaching Lead in the Mood Disorders Centre at The University of Exeter. Paul is an editor of The Oxford Guide to Low Intensity CBT Interventions, chairs the PWP accreditation committee and is a member of the PWP Special Interest Group. Paul is an active researcher in the field of Low Intensity Interventions and CBT Self-Help.

References:
Bennett-Levy, J., Richards, D., Farrand, P et al (Eds.) (2010) Oxford Guide to Low Intensity CBT Interventions. Oxford: Oxford University Press.
Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M & Westbrook, D. (Eds.). (2004) Oxford Guide to Behavioural Experiments in Cognitive Therapy. New York: Oxford University Press
David Richards & Mark Whyte (2009) Reach Out. National Programme Educator Materials to Support the Delivery of Training for Psychological Wellbeing Practitioners Delivering Low Intensity Interventions. 2nd Edition. Rethink.

WORKSHOP 16

Implementing Cognitive Behaviour Therapy Self-Help Resources
Christopher Williams, University of Glasgow and Mark Lau, University of British Columbia, Canada

CBT self-help and other low intensity interventions are increasingly advocated and have a strong evidence base. They prove attractive to many individual practitioners and also to service commissioners who wish to maximise the capacity and through-put of services whilst delivering an evidence-based intervention. Offering planned and structured support significantly increases the clinical efficacy of CBT self-help and this support can be provided equally effectively by face to face and telephone routes. We describe three large funded projects in three countries to illustrate the learning points for practical delivery of low intensity CBT self-help for depression. Lessons are applicable both at the level of the individual practitioner wishing to start working in this way, and also for those wishing to introduce these ways of working into clinical services. In Canada, Mark Lau is the Clinical and Scientific advisor to the Bounce Back programme (www.cmha.bc.ca/bounceback) - a $6 million funded programme which employs non-specialist coaches in 17 communities in British Columbia Canada to support patients' use of CBT self-help resources via telephone. In Scotland, Chris Williams summarises the WISH - Widening Access to Self-Help Programme. This £1 million programme has focused on training the wider workforce to introduce and support CBT self-help into their usual work settings in primary and secondary care. Finally, in England two large primary care based programmes based across NHS East of England and Nottinghamshire illustrate how CBT self-help can be provided as a first step to care delivered via GP's, health visitors and practice nurses using a prescription-based model providing access to online CBT books.
This workshop is aimed at: CBT practitioners wishing to work using low intensity CBT approaches; managers, commissioners and service developers wishing to know about wider role-out models with the existing workforce and in new teams.

Learning objectives:
Attendees will:

  • Gain the knowledge, understanding and practical skills to introduce and support CBT self-help resources.
  • Understand how to structure and support CBT self-help using the Plan, Do and Review model and to use both face to face and telephone support scripts/protocols.
  • Gain a clear overview of the evidence base for CBT self-help and for low intensity working.

Implications for the science and practice of CBT:
For IAPT and other large projects to reach their full potential, there is a need for a far wider range of practitioners to gain skills and abilities to introduce and support low intensity interventions. However, to date in many settings these changes have remained the remit of these specialist teams. This workshop focuses on the wider applicability of these approaches through primary/community based coaches, passing skills on to the existing workforce and also in providing access to CBT self-help approaches in ways that fit GP and primary care based working.

Chris Williams is Professor of Psychosocial Psychiatry at the University of Glasgow and develops and evaluates a range of written, computerised and class based self-help resources. Dr Mark Lau is a Research Scientist and Director of the British Columbia (BC) Cognitive Behaviour Therapy Network, BC Mental Health and Addiction Services, a Clinical Associate Professor of Psychiatry at University of British Columbia, Canada and a Founding Fellow of the Academy of Cognitive Therapy.

References:
Bennett-Levy et al. (2010). The Oxford Guide to Low Intensity CBT Interventions. Oxford University Press: Oxford
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, 37: 1217-1228.
Williams, C. and Chellingsworth, M. (2010). CBT: A clinicians guide to using the five areas approach

WORKSHOP 17

Mindfulness-based Interventions for People with Intellectual and Developmental Disabilities: Reducing Psychological Distress and Facilitating Personal Transformation
Nirb Singh, Angela D.A. Singh, Ashvind N. A. Singh, and Judy Singh, American Health and Wellness Institute, USA

Mindfulness is a recent addition to the armamentarium of cognitive behavioural therapists. Mindfulness methods from wisdom traditions, as well as from current psychological theories, are beginning to be used as cognitive behavioural strategies for alleviating psychological distress and for personal transformation.  Although use of mindfulness as a clinical tool is in its infancy, giant strides have been made in terms of its broad application across various psychological, psychiatric and medical conditions.  This workshop will focus on a range of strategies that can be used for varied purposes, both in the amelioration of psychological distress and for personal transformation.  This workshop will include (a) an explanation of concepts and methods, and (b) opportunities for the participants to engage in and experience mindfulness-based strategies.

Learning objectives:

  • Nature of mindfulness in daily life
  • Applications of mindfulness procedures
  • Evidence for application of mindfulness-based procedures
  • Practice sessions in mindfulness meditation
  • Developing a personal meditation practice

Implications for the science and practice of CBT:
Mindfulness-based procedures are probably the fastest growing therapeutic modality in CBT.  The procedures that will be presented in the workshop will enable clinicians to begin using them with their clients in everyday clinical practice, especially if clinicians already have a personal meditation practice.  If not, the workshop leader will teach clinicians how to develop a personal meditation practice.

Nirbhay N. Singh, a Professor of Psychiatry, Pediatrics, and Clinical Psychology at Virginia Commonwealth University School of Medicine until his retirement from academia, is currently a mental health consultant, researcher, and advocate for people with disabilities.  He has published extensively and is editor-in-chief of two research journals: Journal of Child and Family Studies and Mindfulness. He is also the editor of the book series, Mindfulness and Behavioural Health. Dr. Singh has been involved in the practice and application of mindfulness for many years.

References:
Didonna, F. (2009).  Clinical handbook of mindfulness.  NY: Springer.
Shapiro, S.L., & Carlson, L.E. (2009).  The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions.  Washington, DC: APA.
Singh, N.N., Lancioni, G.E., Wahler, R.G., Winton, A.S.W., & Singh, J. (2008).  Mindfulness approaches in cognitive behavior therapy. Behavioural and Cognitive Psychotherapy, 36, 659-666.

WORKSHOP 18

Cognitive Behaviour Therapy and ACT for caregivers of the frail elderly?
Andrés Losada, Universidad Rey Juan Carlos, Madrid, Spain, and María Márquez-González, Universidad Autónoma de Madrid, Madrid, Spain

Dementia caregivers face demanding tasks for many hours a day during a long period of time. CBT interventions have proven to be the most beneficial for them, although, at best, moderate effects have been obtained. In this workshop, a currently running project in which CBT and ACT individual interventions are offered to caregivers will be described. The efficacy of these two types of interventions will be analyzed as a function of the caregiver´s cognitive-emotional profile. Specific examples of therapeutic tools for managing problems usually observed in caregiving contexts, such as strategies to promote self-care activities, behavioural activation or clarification and commitment with personal values, will be described and discussed, illustrating their explanation with real examples of caregivers treated in our programs. In addition, several measures specifically developed for assessing treatment implementation and outcome measures will also be described (e.g., dysfunctional thoughts about caregiving questionnaire or experiential avoidance in caregiving questionnaire).

Learning objectives:

  • Acquiring knowledge about possible tools for selecting one type of intervention or another depending on the assessment of cognitive-emotional variables.
  • Therapeutic strategies for promoting behavioural or cognitive change or acceptance in people suffering chronic stress

Implications for the science and practice of CBT:

  • Suggestions for the assessment of the cognitive-emotional profile of people suffering chronic stress
  • How to select the type of intervention that would be most appropriate for the person suffering chronic stress.
  • Use of specific therapeutic strategies for promoting change or acceptance

María Márquez-González and Andrés Losada are professors of clinical psychology and researchers from the Group Cuid-Emos (docentes.cs.urjc.es/~alosada/index.htm). During more than 10 years they have developed and tested CBT and ACT group and individual therapy interventions for dementia caregivers, through research projects that have been funded by the Spanish Ministry of Science and Education and the Spanish Ministry of Science and Innovation.

References:
Losada, A., Márquez-González, M. & Romero-Moreno, R. (in press). Mechanisms of action of a psychological intervention for dementia caregivers: effects of behavioral activation and modification of dysfunctional thoughts. International Journal of Geriatric Psychiatry.
Márquez-González, M., Romero-Moreno, R. & Losada, A. (2010). Caregiving issues in a therapeutic context: new insights from the Acceptance and Commitment Therapy approach. In N.A. Pachana, K. Laidlaw & B. Knight (Eds.). Casebook of Clinical Geropsychology: International Perspectives on Practice. New York: Oxford. University Press.
Márquez-González, M., Losada, A., Izal, M., Pérez-Rojo, G. & Montorio, I. (2007). Modification of Dysfunctional Thoughts about Caregiving in Dementia Family Caregivers: description and outcomes of an Intervention Program. Aging & Mental Health, 11, 616-625.

WORKSHOP 19

An Introduction to the Latest Developments in Cognitive Behaviour Therapy for Psychosis
Doug Turkington, Newcastle University and Sara Tai, University of Manchester

Cognitive Behavior Therapy for psychosis has continued to evolve since first described in the early 1990s. Models and formulations have become more refined and the interface with other interventions has become clearer. This workshop will introduce the attendee to the basic concepts and show how these have been added to over recent years. A complete overview of the development of CBT for psychosis will be given bringing the attendee bang up to date. There will be descriptions not only of the key basic techniques but also more advanced strategies such as using graded behavioural experiments, schema level techniques, approaches for trauma within psychosis, use of mindfulness, compassionate mind, metacognitive and method of levels. It will not be possible to go into this panorama of strategies in great detail but there will be opportunity for discussion around the cases presented.

Learning objectives:

  • The current status of CBT for Psychosis will be understood as techniques developed from its roots to the present day.
  • Basic strategies will be understood
  • Key up to date developments will have been witnessed

Implications for the science and practice of CBT:
CBT for psychosis practitioners will be more aware of not only basic techniques but also a range of other possible options with treatment resistant symptoms.

Douglas Turkington is one of the pioneers of CBT for Psychotic disorders and has written 10 books on the subject including two influential manuals. He is actively involved in research on cognitive models, stigma reduction, effectiveness and implementation. Sara Tai is actively involved in research on CBT for psychosis in the UK (CBT for delusions of control), China (group CBT for hallucinations), USA (CBT and CAT for schizophrenia & CBT for medication concordance)

References:
Hagen, D., Turkington, D., Berge, T. & Grawe, R.W. (eds) (2010) CBT for Psychosis. A symptom-based approach. Routledge Press, East Sussex/ New York.
Tai, S. & Turkington, D. (2009) The evolution of Cognitive behaviour therapy for schizophrenia: current practice and recent developments. Schizophrenia Bulletin, 35 (5), 865-873.

WORKSHOP 20

Cancelled

WORKSHOP 21

Cognitive Behaviour Therapy in Complex and Comorbid Cases: Looking for Patterns and Developing Treatment-Guiding Hypotheses
Mark Freeston, Newcastle University

In CBT we have a number of different ways of representing client presentations that have different uses, strengths, and limitations.  These include problem lists, “hot cross buns”, formulations representing both longitudinal and cross-sectional hypotheses, and highly individualized representations based on theoretical models.   It is proposed that all of these may struggle at times to generate helpful hypotheses with complex/comorbid presentations.  With comorbid cases, these familiar types of representations may interfere with recognition of important functional relationships between different parts of the presenting problems that have potential implications for effective treatment.  It is argued that these functional relationships may become more obvious at an intermediate level of specification. It is proposed that comorbid/complex cases will vary infinitely at a highly detailed and individualized level, but they may fit a finite number of patterns (and large number of combination of patterns) at an intermediate level.  Identifying these basic patterns provides a way into complex and comorbid cases.

Learning objectives:

  • By the end of the workshop participants will have become familiar with some of the more common types of pattern of associations between disorders and their implications, and will be familiar with an approach for generating treatment guiding hypotheses when new and complex presentations arise.

The workshop assumes a familiarity with diagnostic systems (ICD and/or DSM) as a helpful shorthand to describe symptom patterns and syndromes, but will consider the types of psychological links that may be present in complex and comorbid presentations.  It also assumes familiarity with standard models and approaches for anxiety disorders, depression, and other disorders with a CBT evidence-base for both the models and the treatment.

Implications for the science and practice of CBT:
This workshop considers a number of possible types of relationship between axis I disorders (such as anxiety disorders and depressive disorders), and between axis I and axis II disorders (i.e. personality traits and disorders). In the face of inevitable comorbidity and complexity, this approach can help clinicians generate plausible hypotheses that can guide treatment such as i) where to start, ii) how to sequence or combine interventions based on or drawn from evidenced based therapeutic approaches, iii) anticipate and avoid possible difficulties, and iv) recognize pitfalls and find possible solutions.

Mark Freeston has worked in the development of CBT models and treatment approaches for OCD and GAD over 20 years and has spent the last 10 years developing and delivering CBT training from novice to advanced levels.  He has an academic post at Newcastle University and is Director of Research and Training at the Newcastle Cognitive and Behavioural Therapies Centre.

References:
Olatunji, Bunmi O, Cisler, Josh M & Tolin, David F. (2010). A meta-analysis of the influence of comorbidity on treatment outcome in the anxiety disorders. Clinical Psychology Review, 30, 642-654.
Allen, Laura B, White, Kamila S, Barlow, David H, Shear, M. Katherine, Gorman, Jack M & Woods, Scott W. (2010). Cognitive-behavior therapy (CBT) for panic disorder: Relationship of anxiety and depression comorbidity with treatment outcome. Journal of Psychopathology and Behavioral Assessment, 32, 185-192.

WORKSHOP 22

Improving Outcomes for Poorly Responding Clients
Michael Lambert, Brigham Young University, USA

Despite the fact that 40-60% of clients return to a state of normal functioning following relatively brief doses of psychotherapy(12-20 sessions) 40 60% of patients do not, and an average of 8% of patients deteriorate during treatment. Unfortunately therapists appear to be unable to predict who will be a treatment failure, thus the problem of negative outcome persists. Effective methods have been developed that identify cases at risk for negative outcome and organize clinician problem-solving with such cases—thereby maximizing treatment outcomes.

Learning objectives:

  • Participants will be able to understand and use clinician reports that alert them to cases at risk for treatment failure.
  • Clinicians will be able to understand and use clinical problem-solving tools to enhance patient outcome.
  • Participants will be able to summarize research results that justify fundamental changes in routine practice

Implications for the science and practice of CBT:
Systematic monitoring with alarm-signals and problem-solving maximizes patient outcome. Implementing the recommended procedures will improve patient outcomes.

Michael Lambert is a Professor of Psychology who specializes in negative treatment effects and how to minimize them. He recently published “Prevention of Treatment Failure” and has developed an evidence-based intervention that blends monitoring treatment response and problem-solving tools for use in routine care and regardless of the kind of psychotherapy on offer. He has given workshops on this topic though out the world.  In addition to this specialty he is a practicing psychotherapist and supervisor of psychotherapy in the Clinical Training Program at Brigham Young University. In 2004 he edited the 5th Edition of Bergin & Garfield’s Handbook of Psychotherapy & Behaviour Change, perhaps the most authoritative and influential scholarly summary of psychotherapy outcome and process. He is currently working on the 6th edition of this Science Citation Classic.

References:
Lambert, M. J. (2010). Prevention of treatment failure: The use of measuring, monitoring, & feedback in clinical practice. Washington, DC: American APA Press.
Shimokawa, K., Lambert, M. J., & Smart, D. W. Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. (2010). Journal of Consulting & Clinical Psychology, 78, 298–311.