PRE-CONFERENCE AND IN-CONFERENCE WORKSHOPS

Tuesday 16th July AND Wednesday 17th July 2013.
9.30 am - 5.00pm

A programme of one-day workshops will be held on Tuesday 16th July. There will also be a programme of one day workshops on Wednesday 17th July. These workshops offer participants an opportunity to develop practical skills in the assessment and treatment of a range of problems.


  Tuesday 16th July
  Eni Becker

 

Exposure therapy for Generalized Anxiety Disorder

Eni Becker,
Radboud University Nijmegen, The Netherlands

Workshop 1 - Full details

Background: This workshop focuses on the use of in-sensu and in-vivo exposure in the treatment of Generalized Anxiety Disorder. At the centre of the intervention are the excessive worries that patients with GAD suffer from. Worrying seems to be a special way of cognitive avoidance. Patients with GAD suffer from a strong intolerance of intense emotions,  eliciting the worry process to down regulate them. Worry exposure is targeting those feared emotions. In this workshop, background will be given on GAD and its diagnosis, as well as a more in-depth look at the worry process. Furthermore, details will be given on how patients can be motivated to participate in exposure treatment, and how the exposure is conducted. Opportunity for practice will be provided. Exposure in-vivo is accompanying in-sensu exposure interventions in GAD, but since GAD patients seem to show little overt avoidance, exposure in vivo is mostly geared towards overcoming safety behaviours. Possible exercises will be discussed and exposure plans will be designed. Exposure treatment can be a very effective way to treat GAD, if the specific characteristics of GAD are taken into account.

Learning objectives:

  • To understand of the worry process
  • Learn how to motivate the patient for exposure in vivo
  • To learn how to do worry exposure
  • Explore how to do exposure in vivo in patients with GAD

Training modalities:
- role-plays

Implications for everyday clinical practice of CBT: Worry is a common phenomenon that is predominant in GAD, but also occurs in other disorders. This workshop will help to treat patients who worry excessively.

Leader: Prof Eni Becker is the Chair of Clinical Psychopathology and the Director of the research program " Experimental psychopathology and treatment" of the Behavioural Science Institute at the Radboud University Nijmegen. She is also chair of Nij-CARE (Nijmegen Centre of Anxiety research and Expertise). She studied at the Philipps-University of Marburg, Germany, getting her PhD in 1996. She was Visiting scholar at the Department of Psychiatry and Behavioural Sciences, Stanford University. (1991-1992), and then Assistant Professor (1996-2003) and Junior Professor (2003-2004) at the Institute of Clinical Psycho­logy, Technical University of Dresden. Professor Becker is trained as a behaviour therapist at the Dresden Academy of Psychotherapy (DAP) (1996-2000). Since 1996 she has regularly been giving courses for therapists in behaviour therapy on the treatment of Anxiety Disorders. Her research interests are cognitive processes in anxiety and depression, as well as cognitive bias modification, approach and avoidance behaviour, and Behaviour therapy for Generalized Anxiety Disorder.

References:
Hoyer, J., Beesdo, K., Gloster, A. T., Runge, J., Höfler, M., & Becker, E. S. (2009). Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder. Psychotherapy and Psychosomatics, 78(2),106-115.

Mennin (2004). Emotion Regulation Therapy for Generalized Anxiety Disorder. Clinical Psychology and Psychotherapy, 11, 17–29.

  David M Clark

 

Cognitive Therapy for Social Anxiety Disorder

David M Clark,
University of Oxford

Workshop 2 - Full details
Background:  Social anxiety disorder is common and remarkably persistent in the absence of treatment. It frequently leads to occupational and educational underachievement. Interpersonal relationships are impaired. Dissatisfaction with the way that life is progressing often triggers depressive episodes and there is a heightened risk of alcohol and drug abuse.

Clark and Wells (1995) proposed a cognitive model that aims to explain why social anxiety disorder is so persistent. A distinctive form of cognitive therapy that targets the maintenance processes classified in the model was developed. Randomised controlled trials in the UK, Germany and Sweden have demonstrated that the new treatment is highly effective. Between 60% and 80% of patients recover, with many others showing worthwhile benefits. Comparisons with other active treatments have established that cognitive therapy is superior to: two forms of group CBT, exposure therapy, interpersonal psychotherapy, psychodynamic psychotherapy, SSRIs, medication-focussed treatment is usual, and placebo medication. Such a comprehensive demonstration of differential effectiveness is extremely rare in psychotherapy.

The workshop provides a comprehensive practical guide to cognitive therapy for social anxiety disorder. It starts with an overview of the cognitive model, focusing on its treatment implications. Each of the steps in treatment is then described and illustrated with case material and videos of treatment sessions. Guidance on the use of the most appropriate measures for identifying therapy targets and monitoring progress is also provided.

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

  • Identify key processes in maintaining social anxiety disorder
  • Develop an individual version of the cognitive model with their patients and
  • Identify appropriate therapeutic techniques

Implications for everyday clinical practice of CBT: Recent research shows that there is a strong relationship between the competence with which the specific techniques of cognitive therapy are implemented and the outcomes that the patients achieve when being treated for social anxiety disorder. This workshop is therefore likely to be extremely helpful in facilitating clinicians’ work with individuals who suffer from social anxiety disorder.

Leader: David M Clark is well known for his cognitive therapy research. With colleagues, he has developed new and highly effective forms of cognitive therapies for panic disorder, post-traumatic stress disorder, and social anxiety disorder. In all three instances, the treatments are recommended as first choice interventions in the relevant NICE Clinical Guidelines.

References:
Clark, D.M. and Wells, A. (1995). A cognitive model of social phobia. In RG Heimberg, M. Liebowitz, D.Hope & F.Scheier (Eds) Social Phobia: Diagnosis, Assessment and Treatment. Pp 69-93. Guilford: New York.

Clark, D.M. (2001) A cognitive perspective on social phobia. In R. Crozier   and L.E. Alden (eds) International Handbook of Social Anxiety Wiley; Chichester, UK

Clark, D.M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M.J.V., Waddington, L., Grey, N, and Wild, J. (2006). Cognitive therapy and exposure plus applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568-578.

Stangier, U., Schramm, E., Heidenreich, T., Berger, M., & Clark, D. M. (2011). Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: a randomized controlled trial. Archives of General Psychiatry, 68 (7), 692-700. doi: 10.1001/archgenpsychiatry.2011.67

  Mellanie Fennell

 

Cultivating Self-Esteem: A Transdiagnostic Cognitive-Behavioural Perspective

Melanie Fennell,
University of Oxford

Workshop 3 - Full details

Background: Cognitive therapy for low self-esteem (while retaining the precision of evidence-based focussed psychological cognitive therapies for anxiety and depression) has the explicit intention of enabling therapists to work effectively with clients whose difficulties cross diagnostic boundaries or are not readily encapsulated within them. The workshop uses Beck’s seminal cognitive model of emotional disorder as a framework for understanding how the problem might develop, and what keeps it in place. The model forms a basis for a coherent problem of cognitive behavioural interventions, designed to help clients to undermine old, negative beliefs about the self, and to establish and strengthen new, more accepting and kindly perspectives.

Key learning objectives:
By the end of the workshop, participants will be able to:

  • Describe the place of low self-esteem in Beck’s cognitive theory of emotional disorder
  • Conceptualise a case of low self-esteem using a structured cognitive-behavioural model as a framework
  • Draw on a range of possible methods for fostering metacognitive awareness
  • Help clients to establish and strengthen new, more positive perspectives on the self

Training modalities: This highly interactive workshop interweaves information-giving with practical exercises designed to help participants relate what they learn to specific cases from their own clinical practice. There will be opportunities for discussion and reflection, and an emphasis on applying the workshop material with clients.

Implications for everyday clinical practice of CBT: Low self-esteem is probably one of the problems most commonly encountered in clinical practice. It is associated with a range of painful emotions (including both anxiety and depression), and can undermine the ability to lead a satisfying life, and to form and maintain fruitful relationships. It crosses diagnostic boundaries, and so is not readily encapsulated by current diagnosis-specific cognitive-behavioural models. The workshop offers clinicians a framework for understanding this commonly encountered problem, and for working with it using the rigour and logic of cognitive behaviour therapy in a problem area which goes beyond specific diagnoses.

Workshop leader: Dr Fennell was a pioneer of cognitive therapy and of cognitive therapy training in the UK. As a research clinician in the Oxford University Department of Psychiatry, she has contributed to the development of evidence based cognitive models and treatment protocols for depression and anxiety disorders, most recently Mindfulness-Based Cognitive Therapy for patients with recurrent depression and suicidality. She was a founder member of the Oxford Cognitive Therapy Centre and developed and directed the Oxford Diploma in Cognitive Therapy, the Diploma/MSc in Advanced Cognitive Therapy Studies, and the MSt in MBCT, in collaboration with Oxford University Dept for Continuing Education. Her particular interests are in depression and low self-esteem, writing both for clinicians and for the general public.  Her book Overcoming Low Self-Esteem has become a classic of self-help literature, recommended on the NHS’s self-help scheme, “Books on Prescription”.  In 2002, she was voted “Most Influential Female UK Cognitive Therapist” by the membership of the British Association of Behavioural and Cognitive Psychotherapies.

References:
Fennell, M.J.V.  (1999, 2009)  Overcoming low self-esteem.  Constable & Robinson, London (Audio version now available in the “Talks with your therapist” series)

Butler, G., Fennell, M.J.V. & Hackmann, A. (2008) Cognitive-behavioral therapy for anxiety disorders: Mastering clinical challenges. Guilford, New York (Chapters 4, 6 & 8)

  Mark van der Gaag

 

From Generic CBT to Focussed CBT for Psychotic Symptoms

Mark van der Gaag,
VU University, Amsterdam, The Netherlands

Workshop 4 - Full details

Background: CBT is successful when experiential learning and behaviour change follow cognitive change. Many-experienced CBT therapist have difficulties in designing behavioural experiments to gain crucial new information on odd beliefs that also disconfirm anticipated fears in a way that the patients can overcome avoidance behaviour in a stepwise way. The workshop will start to develop cases formulations that are shared by patient and therapist that both validate the developmental history of the psychotic person and gives directions for treatment. The main focus will be on developing behavioural experiments that are attractive to patients and challenging basic assumptions and expectations.

In the second half of the workshop the focus will be on two subgroups: (1) patients with an ultrahigh risk (UHR) for developing a first psychotic episode and (2) patients with strong negative emotions elicited by persisting hallucinations that depress the patient.

CBT for patients with UHR aims to help them to postpone or prevent psychosis from happening. Education on dopamine sensitisation and the effects of this condition on perception and reasoning is provided, in combination with behavioural experiments, to shed light on perceptual aberrancies and extraordinary experiences.

Competitive Memory Training (COMET) is an intervention using imagery techniques to facilitate access to positive memory networks, and has been shown to be helpful with patients suffering from hallucinations and low mood.

Key learning objectives:

  1. To master a shared case formulation that is attractive and challenging for the patient in order to motivate engagement with behavioural experiments.
  2. To be able to conduct CBT focussed on subclinical psychotic symptoms by first learning to detect cognitive biases in the patient and, second, to dismantle the danger they convey for developing delusions.
  3. To be able to use COMET in patients with hallucinations and depression using imagery techniques when verbal challenging is not helpful.

Training modalities:
Slide presentations.
Role-play to develop high quality case formulation.
Discussion.
Demonstration of the UHR protocol and to do exercises to master the protocol.
Demonstrate the COMET protocol and learn all seven steps by instruction and role-play.

Implications for everyday clinical practice of CBT: CBT is more focussed if it targets particular aspects of psychosis and addresses underlying cognitive processes. If the therapist has access to a wide range of techniques, CBT may be more effective.

Workshop leader: Mark van der Gaag has been involved in CBT for psychosis for two decades. He is a teacher and supervisor accredited by the Dutch Association of Behavioural and Cognitive Therapy. He has conducted randomised controlled trials in CBT for psychosis, cost-effectiveness, prevention of first episodes, treating trauma in people with a psychotic disorder, competitive memory training, metacognitive training, insight training, motivational interviewing, virtual reality exposure treatment in paranoia and in other studies.

Key references:
van der Gaag, M., Nieman, . H., Rietdijk, J., Dragt, S., Ising, . K., Klaassen, R. M. C. & Linszen, . H. (2012). Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: A randomized controlled clinical trial. Schizophrenia Bulletin, 38(6), 1180-1188. doi:10.1093/schbul/sbs105

van der Gaag, M., van Oosterhout, B., Daalman, K., Sommer, I. E., & Korrelboom, K. (2012). Initial evaluation of the effects of competitive memory training (COMET) on depression in schizophrenia-spectrum patients with persistent auditory verbal hallucinations: A randomized controlled trial. The British Journal of Clinical Psychology / the British Psychological Society, 51(2), 158-71. doi:10.1111/j.2044-8260.2011.02025.x

  Lars-Göran Öst,

 

Single Session Treatment of Specific Phobia in the Real World

Lars-Göran Öst,
Stockholm University, Sweden

Workshop 5 - Full details

Background: Specific phobia is the most prevalent of all psychiatric disorders in the general population with a lifetime prevalence of about 13%. However, few people suffering from specific phobia apply for treatment, mainly because they are not aware of the treatment possibilities, or they are afraid that the treatment itself will be worse than having the phobia.

Professor Öst has developed a rapid treatment that is carried out in one single session, which is maximised to 3 hours. The treatment is based on a cognitive behaviour analysis of the catastrophic beliefs the patient has in relation to a possible confrontation with the phobic object or situation. Prolonged exposure is done as a series of behavioural experiments to help the patient test the catastrophic beliefs they have. During the workshop the participants will get video demonstrations of how specific phobias can be treated in a one-session format using prolonged exposure and modelling.

During the last 20 years Professor Öst has conducted 13 randomized clinical studies on phobias of spiders, snakes, blood-injury, injections, dental care, flying and enclosed places in adults and on various specific phobias in children and adolescents. The mean treatment time varies between 2 and 3 hours and the proportion of clinically significant improvement is between 80-94%. The effects are maintained, or furthered, at the 1-year follow-up. These results have been replicated in at least 12 RCTs carried out in Holland, Great Britain, Germany, Norway, USA, Canada, and Australia.

This workshop will include a live demonstration of a single treatment session of snake phobia.

Learning objectives:

  1. To gain detailed knowledge of the general principles in carrying out the one-session treatment.
  2. Learn about the current data base for the one-session treatment.
  3. Observe how the treatment can be done in a live session followed by question.

Training modalities:
Lecture and direct observation

Implications for everyday clinical practice of CBT: The participants will learn that specific phobias is very prevalent, can impair the patient’s daily life to a large extent, and is possible to treat very effectively in just one prolonged session maximised to 3 hours.

Workshop leader: Lars-Göran Öst is Professor Emeritus of Clinical Psychology at Stockholm University, Sweden, and also has a part-time position as Professor at the University of Bergen, Norway. He has published 225 articles, book chapters and books, and runs his own private practice.

References:
T. Davis III, T. Ollendick, & L-G. Öst (Eds.) Intensive one-session treatment of specific phobias. New York: Springer, 2012.

Öst, L-G., Alm, T., Brandberg, M. & Breitholtz, E. One vs. five sessions of exposure and five sessions of cognitive therapy in the treatment of claustrophobia. Behaviour Research and Therapy, 2001, 39, 167-183.

Öst, L-G., Svensson, L., Hellström, K., & Lindwall, R. One-session treatment of
specific phobias in youth: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 2001, 69, 814-824.

  Sheri Johnson

 

Cognitive Behavioural Approaches to Bipolar Disorder

Sheri Johnson,
University of Berkeley, USA

Workshop 6 - Full details

Background: The goal of this workshop will be to provide training in evidence-based psychological approaches to bipolar disorder that are offered as adjunctive approaches to supplement medications.  Psychoeducational, behavioural, and cognitive interventions that help increase awareness of symptoms and their triggers will be covered. The latest treatment developments that consider goal regulation and self-calming in response to incipient manic symptoms will also be described.

Key learning objectives:

  1. Understand basic skills involved in providing psychoeducation and strategies for tailoring psychoeducation to a client’s knowledge level.
  2. Learn to map symptoms, triggers, and treatments using the Lifechart to provide a framework for promoting a sense of control among clients with bipolar disorder.
  3. Learn strategies for identifying and addressing overly negative cognitive styles.
  4. Learn to assess and provide feedback regarding goal dysregulation concerns that are common to bipolar disorder.
  5. Understand skills for addressing goal dysregulation.

Training modalities: Didactic and role play

Implications for everyday clinical practice of CBT:Clinicians will learn interventions strategies for helping clients understand bipolar disorder, improve their illness management skills, and gain better control over depressive and manic symptoms.

Workshop leader: Sheri Johnson, Ph.D., is a Professor of Psychology at the University of California Berkeley, where she is director of the Cal Mania (CALM).  She has conducted research and clinical work focused on bipolar disorder over the past 20 years with funding from the National Institute of Mental Health and the National Alliance for Research on Schizophrenia and Depression. She has published multiple books and over 125 articles.

References:
Caponigro, J., Lee, E., Johnson, S. L., & Kring, A. (2012). Bipolar Disorder for the Newly Diagnosed.  Oakland, CA: New Harbinger Press.

Johnson, S.L., Edge, M. D., Holmes, M. K., & Carver, C. S. (2012). The Behavioral Activation System and mania.  Annual Review of Clinical Psychology, 8, 243-267, DOI: 10.1146/annurev-clinpsy-032511-143148

Lam, D. H., Jones, S. H., Hayward, P., & Bright , J. A. (1999). Cognitive Therapy for Bipolar Disorder: A Therapist's Guide to Concepts, Methods and Practice.  West Sussex, England: Wiley Press.

Colom, F., & Vieta, E. (2006). Psychoeducation Manual for Bipolar Disorder. Cambridge, England: Cambridge University Press.

   
Workshop 7 - Cancelled

Background: Whilst evidence about effective interventions to change behaviour is accumulating, the ‘active ingredients’ within such intervention packages are often unclear. A necessary step for investigating this is to develop a shared language for describing the content, especially the ‘active ingredients’ of such interventions. This will facilitate the replication of effective interventions, the synthesis of evidence in systematic reviews, and the understanding of the causal mechanisms underlying behaviour change. With the guidance of a multidisciplinary International Advisory Board of leaders in the field of behaviour change, we have developed a method of specifying Behaviour Change Techniques (BCTs), with consensually agreed labels and definitions (see www.ucl.ac.uk/health-psychology/BCTtaxonomy) and shown that it enables reliable specification of intervention content.

The purpose of this workshop is to facilitate skill development in using the developed BCT Taxonomy v1 to clearly and accurately describe the content of behaviour change interventions. Training tasks will teach participants a structured method of how to write clear, replicable descriptions of intervention content using the taxonomy. Participants completing the workshop will be invited to join the Network of collaborators which will facilitate contact with others using and continuing to develop this resource. We will offer individual feedback to participants about their performance in using the BCT Taxonomy to write intervention descriptions. Therapists will be encouraged to use cases from their own experience to identify and describe the interventions that they are using.

The workshop is open to all participants with an interest in investigating, reviewing, designing or delivering behavioural interventions. No previous knowledge or experience of BCT taxonomies is required.

Key Learning Objectives:

  1. To familiarise participants with the need for the BCT Taxonomy, its method of development, its evaluation and its application.
  2. To give hands-on experience of using BCT labels and definitions to describe the content of behaviour change interventions.
  3. To encourage discussion between participants about their experiences of using BCT labels and definitions and future uses of the taxonomy.

Training Modalities: The workshop will combine brief instructor-led presentations, hands-on practice (individually and in groups) and structured discussion.

Implications for everyday clinical practice of CBT: Clinical interventions incorporating CBT are often ‘complex’ involving several, potentially interacting techniques. If we are to implement interventions and therapies shown to be effective in research trials, we need to know precise details of their content. In addition, if we are to build evidence of effectiveness from investigating routine clinical practice, we need to know what is being delivered. The BCT Taxonomy provides a tool for doing this which can strengthen both scientific and clinical practice.

Workshop leaders: Susan Michie is a Registered Clinical and Health Psychologist, and Professor of Health Psychology at University College London. She is a Fellow of the Academy of Social Sciences, the European Health Psychology Society (EHPS) and the British Psychological Society (BPS).  Her research focuses on developing and evaluating behavioural interventions in two health domains: professional practice (e.g., the implementation of evidence-based guidelines, such as hand-hygiene amongst hospital staff), and risk factors amongst the general population (e.g., smoking, physical activity, preparing for pandemic flu).

Marie Johnston has been a member of BABCP for over 30 years.  She is a Registered Health and Clinical Psychologist, and Professor of Health Psychology at the University of Aberdeen. She is a Fellow of the BPS, the Royal Society of Edinburgh and the Academy of Medical Sciences and Academician of the Academy of Learned Societies for the Social Sciences. She conducts research on disability (theory, measurement and intervention) and on behaviour change in health and healthcare contexts.

References:
Michie, S., Abraham, C., Eccles, M., Francis, J., Hardeman, W., Johnston, M. (2011). Strengthening evaluation and implementation by specifying components of behaviour change interventions: a study protocol. Implementation Science, 6, 10. doi:10.1186/1748-5908-6-10

Abraham, C., Michie, S. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychology, 27, 379-387. doi:10.1037/0278-6133.27.3.379

Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., Eccles, M., Cane, J. & Wood, CE. (In press). The Behavior Change Technique Taxonomy (v1) of 93 hierarchically-clustered techniques: building an international consensus for the reporting of behavior change interventions, Submitted for publication with Annals of Behavioral Medicine.

Michie S, Johnston M. (In press). Behavior change techniques. In Gellman MD, Turner JR. Encyclopaedia of Behavioral Medicine. New York: Springer.

   
Workshop 8 - Cancelled

 

  Rona Moss Morris

 

Behavioural (low intensity) Interventions for people with Medically Unexplained
Symptoms or Functional Symptoms


Rona Moss Morris,
King's College London

Workshop 9 - Full details

Background: This workshop is based on a theoretical and empirical model of MUS, referred to henceforth as FS.  The model proposes that FS are precipitated by events such as an infection, injury and/or stress in vulnerable individuals, including those who are genetically predisposed, prone to distress, and high achievement. A self perpetuating cycle where physiological changes, illness beliefs, avoidance behaviours, reduced and/or inconsistent activity, sleep disturbance, medical uncertainty and lack of guidance interact to maintain symptoms and disability.  This workshop will illustrate how to use this model to engage, assess and treat patients with FS using a low intensity approach.  Factors will also be discussed which indicate that patients should be directly referred for a more high intensity approach.  

Key learning objectives:
By the end of this workshop participants will be able to:

  1. Discuss issues of terminology and language use in FS.
  2. Describe evidenced based cognitive behavioural (CB) models of FS.
  3. Apply these CB models to engage patients with FS in behaviourally based treatments.
  4. Apply these models to assess factors which maintain symptoms, disability and distress in people with FS.
  5. Apply evidenced based principles of graded activity and graded exercise to treatment for people with FS. 

Training modalities: Short lectures, group discussion, individual pen and paper exercises (identifying maintaining factors, case formulation etc), role plays.

Implications for everyday clinical practice of CBT: This workshop will provide background information and behavioural methods for engaging, assessing, and treating patients with a range of FS.

Workshop leader: Rona Moss-Morris is Professor of Psychology as Applied to Medicine and Head of  Health Psychology Section at the Institute of Psychiatry, King’s College London.  She is a National Advisor to the Department of Health for IAPT for People with Long Term and Medically Unexplained conditions and represents the BPS on the Clinical Advisory Board of the British Society of Gastroenterology.  She has been researching psychological factors that affect symptom experience and adaptation to  chronic conditions for the past 19 years.  This research has been used to design cognitive behavioural interventions for a range of patient groups.  Randomised controlled trials to test the efficacy of these interventions form a key component of her research.  Professor Moss-Morris is a past journal editor and her work has been published in leading medical and psychology journals and texts. 

References:
Deary V, Chalder T, and Sharpe M (2007). The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clinical Psychology Review 27:781-97.

Moss-Morris R, Spence M, and Hou R. (2010). The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map? Psychological Medicine, doi:10.1017/S003329171000139X

http://www.pacetrial.org/docs/get-therapist-manual.pdf

http://www.pacetrial.org/docs/get-participant-manual.pdf

  Silvia Schneider

 

TAFF - Separation Anxiety Treatment Program for Families: A family-based Cognitive-Behavioural Treatment Program for Children with Separation Anxiety Disorder

Silvia Schneider,
Ruhr-Universität Bochum, Germany

Workshop 10 - Full details

Background: Separation Anxiety Disorder (SAD) is one of the most common anxiety disorders in childhood. Longitudinal studies have provided evidence that children with separation anxiety disorder are at a higher risk to suffer from an anxiety disorder (most commonly a panic disorder/agoraphobia) in adulthood. Furthermore, children with SAD show increased incidence of depression or substance abuse/dependence as adults. The workshop will introduce TAFF – Separation Anxiety Treatment Program for Families. Unlike most existing treatment programs for children with separation anxiety disorder, TAFF follows a family-based treatment approach, including 4 sessions with the child alone, 4 sessions with the parents alone and 8 sessions with both the child and the parents. The treatment program includes working on parents’ dysfunctional cognitions concerning separation anxiety, promotion of parenting competence, fostering the child’s autonomy as well as exposure in vivo. Two treatment studies showed that the TAFF program significantly reduces separation anxiety symptoms and improves self-efficacy and life quality in children with separation anxiety disorder (5-13 years of age).

Key learning objectives:

  • How important is the inclusion of the parent into the treatment of SAD?
  • To learn the main treatment ingredients in anxiety treatment of children
  • To explore conducting exposure in vivo in children

Training modalities:
Case reports
Role plays
Discussion of delegates own patients

Implications for everyday clinical practice of CBT:
Feasibility of CBT with children with anxiety disorders
Feasibility of manualized treatment programme for children with separation anxiety disorder and their parents
Improvement of the child’s self-efficacy and quality of life
Promotion of parenting competence

Workshop leader: Prof. Dr. Silvia Schneider is a researcher in clinical psychology with a strong focus on anxiety disorders in children and their treatment. She is trainer and supervisor for CBT in children and adults. She is head of Clinical Child and Adolescent Psychology at the Ruhr-Universität Bochum as well as the Mental Health Research and Treatment Centre in Bochum. She has developed several treatment manuals and diagnostic tools for anxiety disorders in children and adults.

References:
In-Albon, T., & Schneider, S. (2007). Psychotherapy of childhood anxiety disorders: A meta-analysis. Psychotherapy and Psychosomatics, 76, 15-24.

Schneider S, Blatter J, Herren C, Adornetto C, In-Albon T, Lavallee K (2011) Disorder-specific cognitive-behavioral therapy for separation anxiety disorder in young children: A randomized waiting-list-controlled trial. Psychother Psychosom 80:206–215.

Schneider S, Blatter J, Herren C, In-Albon T, Adornetto C, Meyer, A., Lavallee K. (submitted) The efficacy of a family-based cognitive-behavioral treatment for Separation Anxiety Disorder in children aged 8­–13: A randomized comparison with a general anxiety program.

   
Workshop 11 - Cancelled

 

  Mark Williams

 

Cognitive Therapy and Suicidality

Mark Williams,
University of Oxford

Workshop 12 - Full details

Background: Suicidality is a common and distressing symptom of major depression. Recurring ideas about suicide and suicidal behaviour are one of the risk factors for eventual death by suicide.  An inherent problem in offering help to suicidal clients is that thoughts such as “This world would be better off without me” or “I am a burden to my family” are distressing both to them, their family, and to clinicians offering help.  With the best of intentions, clinicians (who need to take these thoughts seriously), may thereby unwittingly help to maintain the very symptoms that they wish to help reduce.

In previous work, we have developed a psychological treatment (mindfulness-based cognitive therapy - MBCT) that has been shown in six randomised controlled trials to reduce risk of recurrence in major depression.  MBCT combines Jon Kabat Zinn’s Mindfulness-based Stress Reduction program with psychoeducation from Cognitive Therapy and is offered, in an eight week ‘class’ format, to patients who have recovered from their depression or suicidal crisis.

It aims to teach participants how to become aware of early warning signs of relapse, and to reduce tendencies to avoid these early signs.  It includes breathing meditation and mindful movement practice to help participants become more aware of moment-to-moment changes in the mind and the body that might provide early warning of down-turns in mood. It also includes basic education about depression, and exercises from cognitive therapy that emphasise the links between thinking and feeling. 

The workshop will focus on whether MBCT can help people who are vulnerable to becoming suicidal during episodes of depression.  Offering mindfulness training when a person is between episodes – when the thoughts are not so compelling - may be a useful way of preventing future thought-affect spirals, and the workshop will detail the changes we have made to the MBCT protocol for these vulnerable people.

Key learning objectives:

  1. Understanding the theory of recurrence in suicidal depression
  2. Seeing clearly the practical constraints in working with such vulnerable and high risk people
  3. Experiencing some of the mindfulness practices that are offered to such patients and how the MBCT protocol may change to take account of the needs of these participants

Training modalities:
Lecture, discussion and meditation practice

Implications for everyday clinical practice of CBT: Knowing how best to help people who suffer from suicidal thoughts and impulses is extremely difficult. Most clinicians who specialise in this area, and many who do not, will have a client or patient who commits suicide.  There are many skilful ways to approach these issues, and mindfulness-based approaches is only one of these. Yet, we may learn from the new understandings that are emerging from research in this field even if we decide to use an alternative approach.

Workshop leader: Mark Williams is Professor of Clinical Psychology at the University of Oxford’s Departments of Psychiatry and Experimental Psychology.  He has held previous posts at the MRC’s Cognition and Brain Sciences Unit in Cambridge and the University of Wales, Bangor.  He co-developed Mindfulness-based Cognitive Therapy (MBCT), an approach that is now part of the UK’s approved treatments for preventing depression. He is a Fellow of the UK’s Academy of Medical Sciences and the British Academy. 

References:
  1. Williams JMG. and Kuyken W. (2012) Mindfulness-based cognitive therapy:
    a promising new approach to preventing depressive relapse Br. J. Psychiatry doi:10.1192/bjp.bp.111.10474
  1. Williams JMG., Barnhofer T., Crane C., et al. (2012) Pre-Adult Onset and Patterns of Suicidality in Patients with a History of Recurrent Depression Journal of Affective Disorders; 138: 173–179  doi:10.1016/j.jad.2011.12.011

  2. Hargus E., Crane C,. Barnhofer T., & Williams J.M.G. (2010) Effects of Mindfulness on Meta-awareness and Specificity of Describing Prodromal Symptoms in Suicidal Depression. Emotion, 10, 34-42.
  Lucene Wisniewski

 

Using DBT in the Treatment of Eating Disorders

Lucene Wisniewski,
CaseWestern Reserve University and Cleveland Centre for Eating Disorders

Workshop 13 - Full details

Background: Eating Disorder patients who suffer from multiple Axis I and II diagnoses, especially those that include suicidal or self harm behaviours, tend to present as a conceptual and practical treatment conundrum, often leading to therapist burnout and to patient drop out. Dialectical Behaviour Therapy (DBT), originally designed to treat chronically suicidal patients suffering from Borderline Personality Disorder, is a treatment that has been applied to multi-diagnostic, difficult-to-treat patients such as these. DBT offers strategies to address prioritizing multiple treatment targets, including those that can be life threatening in patients with eating disorders as well as prioritizing behaviors that can interfere with treatment and subsequently contribute to patient drop out and therapist burn out.

Key learning objectives:
After this workshop, participants will be able to:

  1. Use a hierarchy to decide which behaviours should be addressed first during an individual therapy session with a complex ED patient.
  2. Identify and target therapy interfering and therapy destroying behaviours in complex ED patients.
  3. Understand the use of contingency management in the treatment of complex ED patients

Training modalities: Via didactic and case presentations as well as role play and discussion, participants will be exposed to DBT skills and treatment strategies as they are applied to ED symptomatology. 

Implications for everyday clinical practice of CBT: DBT is considered a Cognitive Behavioural Treatment. Participants will learn DBT skills that can be used with their eating disorder patients.

Workshop leader:  Lucene Wisniewski, PhD, FAED  is the Clinical Director and co-founder of the Cleveland Centre for Eating Disorders and is an Adjunct Assistant Professor of Psychology at Case Western Reserve University in the United States.   Her research and clinical interests include using empirically founded treatments to inform clinical programs.  She provides workshops on the CBT and Dialectical Behaviour Therapy  (DBT) treatment of eating disorders internationally and publishes in peer reviewed journals as well as invited book chapters.  Dr. Wisniewski has been elected fellow and has served on the board of directors of the Academy for Eating Disorders. She currently is co-leader of AEDs Borderline Personality Disorder special interest group.  

Key references:
Ben-Porath, D., Wisniewski, L., Warren, M.  (2009). Outcomes of a DBT Day Treatment Program for Eating Disorders:  Clinical and Statistical Significance.  Journal of Contemporary Psychotherapy; 40; 115-123. 

Federici, A., Wisniewski, L. & Ben Porath, D. (in press).   “Description of an Intensive Dialectical Behavior Therapy Program for Multidiagnostic Clients With Eating Disorders.  Journal of Counseling & Development, 

Wisniewski L, Safer DL, Chen E (2007).  DBT for patients with eating disorders.  In L. Dimeff, K Koerner, C Sanderson, & M Byars (Eds.), Adaptations of Dialectical Behavior Therapy.  Guilford Press

  Jeff Young

 

Implementing Emotion-Focused Techniques in Schema Therapy

Jeff Young,
Cognitive Therapy Centre of New York

Workshop 14 - Full details

Background: As Schema Therapy has evolved over the past 20 years, the role of emotion-focused techniques (many of which are based on Gestalt Therapy) has expanded dramatically. Based on our clinical experience and new research in neurobiology, it has become increasingly clear that experiential techniques are often the most direct and powerful means of changing schemas and modes.
After providing a brief overview of the conceptual model, Dr. Young will explore a wide range of evidence based emotion-focused strategies utilized within a Schema Therapy framework, across different disorders and patient types. The techniques covered will be drawn from the following list: schema mode dialogues, childhood imagery, imagery to link past and present, imagery for reparenting, fighting the Punitive Parent, two-chair dialogues, and venting anger.

Training modalities:
Techniques will be illustrated through extensive patient video segments

Implications for everyday clinical practice of CBT: Dr. Young will discuss how to decide which strategies are most appropriate for different patient objectives, based on a thorough schema case conceptualization. He will also illustrate how to overcome obstacles with patients who are reluctant or refuse to try emotion-focused work.

Workshop leader: Jeffery Young is the Director of one of New York's leading psychotherapy centers and lecture internationally on cognitive and schema therapies. His main focus is on emotion & relationships.
Dr. Young was one of the first cognitive therapists trained by Dr. Aaron Beck, the founder of cognitive therapy, and worked closely with him for many years. Dr. Young lectures and trains psychotherapists throughout the world on ways of expanding cognitive therapy to work with chronic, treatment-resistant patients.  
Dr. Young is also the author of many publications related to cognitive therapy, including a popular self-help book on changing life patterns called "Reinventing Your Life."  He has also appeared frequently in major media, such as Good Morning America, Oprah, the New York Times, USA Today, and the Washington Post.

References:
Participants are encouraged to obtain an overview of schema mode work and emotion-focused techniques prior to attending, if possible. These are explained in detail in Dr. Young’s book, “Schema Therapy: A Practitioner’s Guide,” published by Guilford Press.

Young, J.E. & Klosko, J.S. (1993, 1994). Reinventing your life.  New York: Plume Books

Schmidt, N.B., Joiner, T.E., Young, J.E., & Telch, M.J.  (1995).  The Schema Questionnaire:  Investigation of psychometric properties and the hierarchical structure of a measure of maladaptive schemata.  Cognitive Therapy and Research,19(3), 295-321.

 

 

Working with Refugees and Asylum seekers with PTSD

Kerry Young & Jane Herlihy,
University College London & The Trauma Clinic, London

Workshop 15 - Full details

Background: This workshop will aim to give participants a theoretical and practical framework for the cognitive-behavioural assessment and treatment of refugees and asylum seekers with PTSD. Topics covered will be:

  • Epidemiological information
  • The Asylum process and how best to assist your clients within it
  • Working with lawyers
  • Working with interpreters
  • Cultural modifications of CBT
  • What to consider at assessment
  • What theoretical framework to use for formulation
  • Treatment planning
  • How to do reliving and narrative treatments with people who have experienced multiple traumatic events
  • Outcome research in this area
  • How to address some of the cognitive themes common in this group e.g. mistrust, anger and shame

Training modalities: The workshop will involve formal presentations, case discussion, video role-play and group discussion.

Workshop leader: Kerry Young is a Consultant Clinical Psychologist and Clinical Lead of the Forced Migration Trauma Service (London). This is an innovative service offering evidence-based cognitive-behavioural treatment to refugees and asylum seekers suffering from PTSD within a phased, multidisciplinary model of intervention. Kerry also works in Oxford University Department of Psychiatry within the Experimental Psychopathology and Cognitive Therapy Lab (EPACT). She has worked for 16 years in trauma and has written and lectured widely on how to treat simple and complex PTSD and how to work with traumatized asylum seekers and refugees.

Jane Herlihy is the Director of the Centre for the Study of Emotion and Law. She is a Chartered Clinical Psychologist and has been writing and conducting research into the decision-making process in refugee status claims since 2000. Jane worked briefly at the Medical Foundation for the Care of Victims of Torture between 2000 and 2001 and then from 2001 to 2005 at the Refugee Service of the Traumatic Stress Clinic, in London. She currently has a part time clinical role at the Trauma Clinic in London and is an Honorary Lecturer at University College, London.

 

Wednesday 17th July
9.30am - 5.00pm.

 

  Tim Carey

 

The Method of Levels: A Transdiagnostic Approach to Increasing the Efficiency and Impact of CBT.

Tim Carey & Sara Tai
Centre for Remote Health, Australia | University of Manchester

Workshop 16 - Full details

Background: There are numerous challenges for clinicians who provide evidence-based treatments for the wide range of problems patients present with. Often, the patient’s description of the problem doesn’t match the problem outlined in the referral. Moreover, comorbid presentations are the rule rather than the exception; yet many treatments are designed to be disorder specific. Furthermore, while treatments are designed to be provided in regular weekly or fortnightly schedules they are often delivered according to a variable and unpredictable schedule due to cancelled and missed appointments by patients. Finally, many treatments emphasise the utilization of various unique and innovative strategies and techniques yet many of these activities actually reflect common underlying evidence-based principles of effective treatment. A therapy therefore that could be applied transdiagnostically, according to a variable treatment session schedule, and based on robust principles of psychological distress and psychological change, would be extremely useful for primary care clinicians. The Method of Levels (MOL) is a transdiagnostic cognitive therapy that underpins techniques such as exposure and cognitive restructuring. It is informed by the principles of Perceptual Control Theory (PCT) and uses a flexible, adaptive, and effective treatment protocol. The ethos of stepped care is incorporated within this protocol, however, it is the patients rather than the clinicians who direct the “stepping”. MOL engages the resources of the patient to promote their own recovery in a way that is likely to be enduring and generative. MOL takes a transdiagnostic approach by providing treatment centered around the patient’s perspective, and so is well suited to complex problems and long-term conditions as well as addressing some of the more challenging aspects of therapy such as noncompliance, lack of engagement, and poor motivation. MOL can be used as a standalone therapy or can be incorporated into therapist’s existing evidence-based practices to enhance their effectiveness and efficiency. Importantly, the practice of MOL centers around two explicit goals, which can be learned quickly allowing maximum time for practice and consolidation of the questioning approach adopted by MOL therapists. This workshop will present the theory and practice of MOL as a transdiagnostic cognitive therapy. Implications for services will be discussed and research evidence will be presented. A large part of the workshop will involve participants practicing the skills of the MOL in role-play situations as well as having direct experience with evaluative materials in order to become familiar with resources to facilitate progress and improvement.

Objectives: By the end of the workshop the participants will have had opportunities to:

  1. Examine their own implicit models of therapeutic change;
  2. Learn techniques to promote the participation and engagement of patients;
  3. Explore the problem solving process of psychological reorganisation and how best to promote it;
  4. Trouble-shoot ways of addressing and overcoming common problems in therapy such as poor engagement and motivation; and,
  5. Develop ways of delivering cognitive therapy flexibly and adaptively using transdiagnostic methods to ensure each patient receives the optimum amount of therapy.

Modalities: In this workshop a range of training modalities will be used including: didactic, group discussion and problem solving, role play, DVD demonstrations and experiential activities.

Implications: The workshop will be presented by practicing clinicians and will equip participants with skills they will be able to use immediately in order to achieve the following outcomes in their practice:
•   Increased therapist effectiveness through an expanded theoretical framework;
•   Increased therapist confidence through a clearer understanding of how their practices promote therapeutic change for different patients with different problems;
•   Increased patient satisfaction through the provision of effective and efficient treatment;
•   Greater cohesiveness between therapeutic approaches through the recognition of fundamental commonalities; and,
•   Increased therapist confidence in their own ability to work effectively with clients presenting with complex problems and comorbidities through a sound understanding of the transdiagnostic processes that techniques employ in order to work effectively.

Leaders: Dr Tim Carey is an Associate Professor in Mental Health in Alice Springs.  He is a clinician-researcher who has been developing the Method of Levels in Australia and the UK since the late 1990’s. He supervises others in the use of MOL and has conducted training workshops in the UK, Canada, and Australia.
Dr Sara Tai is Senior Lecturer in Clinical Psychology at Manchester University. She is an experienced practitioner, researcher, and trainer of CBT and MOL. She provides supervision and workshops internationally and is involved in research on psychoses and bipolar disorders in China, USA, Europe, and the UK.

References:
1. Carey, T. A. (2008). Hold that thought! Two steps to effective counseling and psychotherapy with the Method of Levels. Chapel Hill, NC: newview Publications.
2. Carey, T. A., Carey, M., Mullan, R. J., Spratt, C. G., & Spratt, M. B. (2009). Assessing the statistical and personal significance of the Method of Levels. Behavioural and Cognitive Psychotherapy, 37, 311-324.
3. Mansell, W., Carey, T. A., & Tai. S. J. (2012). A transdiagnostic approach to CBT using Method of Levels therapy: Distinctive features. London: Routledge.

  Paul Flaxman

 

Acceptance and Commitment Therapy in Groups - Developing Skills for Successful Groups

Paul Flaxman, Joseph Oliver, Eric Morris and Vasiliki Christodoulou
City University, London | South London and Maudsley NHS Foundation Trust

Workshop 17 - Full details

Background: Acceptance and commitment therapy (ACT) has demonstrated efficacy across a wide variety of areas, such as within mental and physical health settings and in the workplace (Bach and Hayes, 2002; Bond & Bunce, 2000; Vowles & McCracken, 2008). Furthermore, a number of studies show that ACT can be efficiently and effectively applied within group formats and skill development can be usefully augmented by the group process (e.g., Hayes et al., 2004; Flaxman & Bond, 2010).

ACT groups are broadly aimed at assisting participants to develop skills required to engage in more effective values based behaviour. This involves:

  • Introducing, developing and practicing specific skills such as mindfulness, acceptance and awareness of thoughts (defusion)
  • Values identification and clarification exercises
  • Practicing engaging in values based behavioural activation
  • Use of the group process to facilitate shared learning and skills development

The workshop facilitators have extensive experience of delivering and empirically evaluating ACT in groups. They will share personal experiences and insights from ACT groups that have been delivered in a number of settings, including staff well-being interventions within the workplace and for people with serious mental health problems such as psychosis.

The workshop will focus on cultivating the skills and knowledge required to set up and facilitate successful ACT groups. The workshop will illustrate ways of presenting ACT-consistent rationale in group training programs; offer tips on harnessing the group process to model and augment ACT’s processes; and demonstrate ways of introducing and conducting physical metaphors (such as Passenger on the Bus and Tug of War with a monster) to promote these processes in a fun and engaging way.

Objectives: Participants will develop the following skills:
• Effectively utilising simplified ACT frameworks that can be used to organise and consolidate learning in ACT groups.
• Using the group process to effectively enhance learning related to key ACT processes
• Presenting and engaging participants in central ACT metaphors within a group setting

Modalities: The workshop will incorporate case material, transcripts, and role plays to illustrate and assist attendees in practically trying out and developing ACT group facilitation skills. Uniquely, the workshop will focus on developing and practicing live group facilitation skills and will use the four workshop leaders to facilitate small group practice.

Implications: Implications for the everyday clinical practice of CBT
The workshop will offer opportunities for clinicians and psychological practitioners to build and develop skills necessary to carry out ACT based interventions. These skill sets will be versatile and practical, with an emphasis on utility for within a wide variety of clinical and workplace settings.

Leaders: Dr. Paul Flaxman has delivered ACT groups in workplace and healthcare settings over the past 10 years. His internationally recognised research has been published in both CBT and occupational health literatures.
Dr Vasiliki Christodoulou is an accredited CBT and mindfulness-based practitioner. She has been delivering and evaluating ACT and mindfulness based group approaches in the workplace, healthcare and educational settings over the past six years.
Dr Joe Oliver and Eric Morris are both clinical psychologists who have been developing and researching ACT for psychosis group formats in NHS settings. Both are experienced trainers and supervisors of therapists in contextual CBT.

References:
Flaxman, P. E., Bond, F. W., & Livheim, F. (2013). The mindful and effective employee. An  Acceptance and Commitment Therapy training manual for improving well-being and performance. Oakland, CA: New Harbinger.

Morris, E., Johns, L. & Oliver, J. (2013). Acceptance and Commitment Therapy and Mindfulness for Psychosis. Wiley-Blackwell.

Walser, R. D., & Pistorello, J. (2004). ACT in group format. In S. C. Hayes & K. D. Strosahl (Eds.), A practical guide to acceptance and commitment therapy. New York: Springer.

  Andrew Gumley

 

Incorporating Attachment Theory into Cognitive Therapy for Emotional Recovery from Psychosis

Andrew Gumley,
Institute of Health and Wellbeing, Mental Health and Wellbeing Research Group

Workshop 18 - Full details

Background: There is growing evidence that stressful developmental experiences and traumatic life events including sexual abuse, being in care and homelessness are linked to increased vulnerability to developing psychosis. Attachment theory has been successful in understanding adaptation to the long-term impact of adverse developmental experiences (e.g. abuse) or stressful life events (e.g. loss). Strong evidence shows that insecure and disorganized attachments are significant risk factors for psychopathology. Attachment theory is a developmental model of interpersonal and psychological functioning, personal resilience and affect regulation, derived from an understanding of the affectionate bonds created in the context of close relationships, initially with primary care-givers. Attachment theory provides a developmental understanding of affect regulation, emerging from the evolutionary necessity for the infant to establish a safe haven (for distress) and secure base (for exploration).
This workshop will be based on an attachment based conceptualisation of recovery from psychosis and will focus on the cognitive, interpersonal and developmental aspects involved in recovery and vulnerability to the recurrence of psychosis. The workshop will outline how attachment theory can provide a framework for developing individually tailored strategies for case formulation, recovery and staying well that primarily focuses on emotional and interpersonal adaptation to psychosis. This approach incorporates:

  • 1. A developmental and interpersonal perspective on help seeking and affect regulation,
  • 2. Strategies to support self reorganisation and adaptation after acute psychosis,
  • 3. Understanding and treating traumatic reactions to psychosis,
  • 4. Working with key threats including feelings of humiliation, entrapment, loss and fear of recurrence appraisals during recovery,
  • 5. Developing coping in an interpersonal context.
Objectives:
  • 1.  To formulate emotional recovery and relapse prevention as reciprocal goals, requiring the development of psychological adaptation and affect regulation skills. ]
  • 2.  To incorporate a developmental perspective to guide the process of service engagement, formulation and intervention.
  • 3.  To develop individualised formulation based approach to emotional recovery, relapse detection and prevention.
  • 4.  To develop a therapeutic frame and clinical services approach around the interplay between key fears, safety strategies and their unintended consequences

Modalities: The workshop will combine didactic, experiential and group work methodology. Clinical illustrations will be provided through video based examples.

Implications: Attachment theory provides an insight into processes and competences underpinning affect regulation that primarily express themselves through the therapeutic relationship and nature of services engagement. This workshop will provide workshop participants with key insights and skills to understand challenges to therapeutic engagement at an individual and systemic level and will provide a framework for incorporating attachment theory into day to day clinical practice.

Leaders: Andrew is a clinical psychologist and is currently Professor of Psychological Therapy in the Institute of Health and Wellbeing, University of Glasgow. Andrew ‘s main interests are in the application of attachment theory to understanding development and adaptation to psychosis.
Matthias is a clinical psychologist in the Early Psychosis Support Service at CAMHS Lothian and Professor of Clinical Psychology in the Section of Clinical and Health Psychology at the University of Edinburgh.  Matthias’ main research and clinical interest is the developmental and interpersonal context of severe mental health problems, psychosis and recurrent mood disorders. 

References:
Gumley A, O'Grady, M, McNay, L, Reilly, J, Power, K & Norrie, J (2003). Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychological Medicine, 33, 419-431.

Gumley AI & Schwannauer M. (2006) Staying well after psychosis: a cognitive interpersonal approach to recovery and relapse prevention. Chichester: John Wiley & Sons Ltd.

Liotti G. & Gumley A.I.  An attachment perspective on schizophrenia: Disorganized attachment, dissociative processes, and compromised mentalisation. A. Moskowitz, M Dorahy, I Schaefer (Eds) Dissociation and Psychosis: Converging Perspectives on a Complex Relationship. John Wiley & sons Ltd (2009)

   
Workshop 19 - Cancelled

Description: This workshop focuses on assessment and treatment of anxiety in preschool children (3-5 years). The workshop covers general information on anxiety disorders including diagnostic criteria, assessment techniques and current research findings on factors that maintain anxiety and how this links with treatment approaches. The workshop provides specific training on the ‘Cool Little Kids’ anxiety program. This program has a cognitive behavioural orientation, is designed to train parents of young children in anxiety management skills .

Key learning objectives:
At the conclusion of the workshop, participants should be able to:

  1. Select appropriate assessment techniques to assess for anxiety in young children
  2. Understand the cognitive behavioural model of anxiety in young children
  3. Understand the core components of treatment for anxiety in this population and how each link to the factors that maintain anxiety disorders.
  4. Implement the Cool Little Kids Program with young children and their families.

Training modalities:
Didactic training and small group work
2-3 key references

Implications for everyday clinical practice of CBT
The program and strategies discussed in this workshop are suitable for clinicians working in community, hospital, early-childhood or private settings.   

 

Workshop leader: Jennifer Hudson is a Clinical Research Fellow at the Centre for Emotional Health in the Department of Psychology, Macquarie University, Sydney, Australia. Her research focuses on anxiety disorders in children and adolescents, specifically the role of parents in the aetiology of anxiety disorders in youth and the treatment of internalizing disorders using Cognitive Behavioural Therapy. Professor Hudson has published her research in international journals. She has co-authored a book 'Treating anxious children: An evidence-based approach' (2000) and edited a book ‘Psychopathology and the Family’ (2006). 

References:

  1. Hudson, J.L. & Dodd, H.F. (2012) Informing Early Intervention: Preschool Predictors of Anxiety Disorders in Middle Childhood. PLoS ONE 7(8): e42359. doi:10.1371/journal.pone.0042359.
  2. Hudson JL, Dodd HF, Lyneham HJ, Bovopoulous N. (2011). Temperament and Family Environment in the Development of Anxiety Disorder: Two-Year Follow-up. Journal of the American Academy of Child and Adolescent Psychiatry. 50(12): 1255-64.
  3. Rapee, R. M., Kennedy, S., Ingram, M., Edwards, S., & Sweeney, L. (2005). Prevention and Early Intervention of Anxiety Disorders in Inhibited Preschool Children. Journal of Consulting and Clinical Psychology, 73(3), 488-497.
  Ray Novako

 

Anger Treatment: Case Formulation and the Stress Inoculation Approach

Ray Novaco & John Taylor
University of California | Northumberland Tyne and Wear NHS Foundation Trust

Workshop 21 - Full details

Background:  Anger dysregulation is a transdiagnostic problem, as it 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 of assessment will be presented.  Case formulation using the author's anger assessment procedures will be practised using an anger dysregulation model. 
CBT anger treatment based on the “stress inoculation” approach will be presented and practised, including cognitive restructuring and arousal reduction in conjunction with provocation scenarios. Fostering behavioural coping skills through imaginal and role play procedures will be illustrated.  Obtaining leverage for change through a “preparatory phase”, which is crucial in work with offender populations, will be covered, including application to clients with intellectual disabilities.  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.

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

Modalities: Case examples of community and hospital clients will be provided for practice. Workshop format will be didactic and experiential with structured exercises.  Illustrations of multiple sessions of the treatment protocol will be given and practised.

Implications: 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.

Leaders:       
Raymond W. Novaco, Ph.D. has extensive expertise on the assessment and treatment of anger with a variety of clinical populations, including those with a history of violence.  His anger measures have been found to have significant value in predicting violence among psychiatric patients before, during and after hositalization, as reported in many independent scientific publications. His on-going assessment and treatment research concerns severe anger in patients having serious clinical disorders, including war veterans with combat-related PTSD and forensic patients in secure facilities, both general psychiatric and intellectually disabled, and domestic violence victims.

John L. Taylor is Professor of Clinical Psychology at Northumbria University and Consultant Clinical Psychologist with Northumberland, Tyne & Wear NHS Foundation Trust. Along with Dr Novaco, he has led the development of modified assessment measures and interventions for people with cognitive deficits who experience severe problems with anger control and aggression. Dr Taylor has published widely on his research and clinical work concerning psychological therapies for people with intellectual and developmental disabilities who have mental health and emotional problems.

References:
Novaco, R. W. (2011). Anger dysregulation: Driver of violent offending.  Journal of Forensic  Psychiatry and Psychology, 22, 650-668.

Novaco, R. W. (2010).  Anger and psychopathology. In M. Potegal, G. Stemmler, & C. Spielberger (Eds.). Handbook of anger (pp. 465-497).  New York: Springer.

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. Chicester, England: Wiley.

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

  Russell Ramsay

 

The Adult ADHD Tool Kit: Using CBT to Help Adults with ADHD

Russell Ramsay,
University of Pennsylvania, USA

Workshop 22 - Full details

Background: CBT has emerged as an evidence-supported, psychosocial treatment of choice for adults with ADHD.  The current session presents the treatment approach of one of the CBT programs for adult ADHD that has been studied (Ramsay & Rostain, 2011; Rostain & Ramsay, 2006).  In the spirit of bridging research and practice, the emphasis on the current session will be on helping illustrate the delivery of the interventions and coping strategies that are helpful for this clinical population.  After a brief review of a CBT model of adult ADHD, its connection with contemporary neurobiological models of ADHD and review of the empirical support, the different categories of coping skills will be reviewed with an emphasis on helping adults with ADHD to be able to implement these skills in their daily lives.  Case examples and participant questions also will be included in the workshop.

Objectives:

  1. Provide a concise definition of the contemporary executive dysfunction model of adult ADHD.
  2. Describe an implementation strategy intervention that will increased the likelihood an adult client with ADHD will use a coping skill outside of the consulting room.
  3. Identify some of the most common cognitive distortions that may interfere with client motivation for and follow through on coping skills.

Modalities: lecture/slides, case examples, participant questions

Implications: The primary emphasis of this workshop is helping clinicians deliver evidence supported CBT to adult clients with ADHD in a way that increases the likelihood that clients will use the skills in their daily lives.  This is a particularly salient point for this clinical diagnosis, which is characterized by difficulties organizing behaviour across time

Leaders: Dr. J. Russell (“Russ”) Ramsay is co-founder and co-director of the Adult ADHD Treatment and Research Program and an associate Professor of Clinical Psychology at the University of Pennsylvania Perelman School of Medicine.  
Dr. Ramsay has authored numerous peer reviewed articles and book chapters, and has lectured internationally on various issues related to adult ADHD.  He is author of Cognitive Behavioural Therapy for Adult ADHD (Routledge, 2008) and Nonmedication Treatments for Adult ADHD (American Psychological Association, 2010). Dr. Ramsay serves on the editorial boards of the Journal of Attention Disorders and the Journal of Psychotherapy Integration. 

References: 
Ramsay, J. R., & Rostain, A. L. (2008). Cognitive behavioural therapy for adult ADHD: An integrative psychosocial and medical approach. New York:
Routledge.

Ramsay, J. R., & Rostain, A. L. (2011). CBT without medications for adult ADHD: An open pilot study of five patients. Journal of Cognitive Psychotherapy: An International Quarterly, 25, 277-286.

Rostain, A. L., & Ramsay, J. R. (2006). A combined treatment approach for adults with attention-deficit/hyperactivity disorder: Results of an open study of 43 patients. Journal of Attention Disorders, 10, 150-159.

  Mary Welford

 

How to Integrate Compassion Focused Therapy (CFT) within Familiar CBT Approaches

Mary Welford,
The Compass Centre for Research Learning and Therapy, UK

Workshop 23 - Full details

Background: CBT has proved to be of great benefit for a range of individuals. If such work produces a sustained improvement in an individual’s wellbeing it can be viewed as the most compassionate approach to adopt and should be recommended.  However, what happens when your client reports they can see the logic but they do not feel any different; they know they are not to blame but they still feel at fault; they know there may be no danger but they still feel as though something terrible will happen, despite all of yours and their best efforts.  In such cases should we do more of the same or try something different?
Compassion Focused Therapy (CFT) was developed by Paul Gilbert as a way of addressing shame and self-criticism.  The therapy aims to ‘tone up’ feelings of contentment, safeness and soothing in order to help regulate the drive and threat systems of the brain.  This helps the individual bridge the gap between knowing something and feeling it.  It is a standalone therapy but aspects of the approach can be ‘sprinkled in’ to other forms of therapy to ‘warm it up’ or allow cognitive work to ‘sink in’.
This skills class will briefly review the theory and practice of CFT before looking at familiar CBT approaches and how CFT may be integrated. 

Objectives:  

  • To gain a brief introduction to Compassion Focused therapy
  • To gain an awareness of how to integrate the approach with more familiar CBT models in order to potentially enhance their effectiveness

Modalities: Powerpoint, experiential, video

Implications: Skills to help 'warm up' CBT
Personal benefit for therapists re their own self compassion

Leaders: Mary Welford is a Consultant Clinical Psychologist and Director of The Compass Centre for Research Learning and Therapy based in the South West.  She is Chair of the Compassionate Mind Foundation and author of The Compassionate Mind Guide to Building Self Confidence.

References:
The Compassionate Mind, Paul Gilbert, Constable Robinson

The Compassionate Mind Guide to building self-confidence, Constable Robinson

Lee, D. A. (2005). The perfect nurturer: A model to develop a compassionate mind within the context of cognitive therapy. In, P. Gilbert (ed). Compassion: Conceptualisations, research and use in psychotherapy (p.326-351). London: Brunner-Routledge.

  Michael Worrell

 

Behavioural Couples Therapy: Extending Therapeutic Skills Beyond a Focus on the Individual

Michael Worrell & Sarah Corrie,
CNWL NHS Foundation Trust

Workshop 24 - Full details

Background: Behavioural Couples Therapy: (BCT) is an evidence-based psychological treatment that has acquired a significant amount of empirical support for the benefits it provides, both in terms of reducing couple distress and improving specific psychological disorders, such as depression. In the respect, it is recognised in the current NICE guidelines for the treatment and management for depression where one partner is experiencing depression and where relationship distress is a significant maintenance factor for the depression.

The workshop aims to introduce participants to a contemporary model of Behavioural Couples Therapy developed principally by Professor Donald Baucom from the University of North Carolina and his colleagues. This model has recently been a focus of a training initiative within the IAPT programme in collaboration with Professor Baucom. This workshop will introduce participants to the contemporary BCT model, the empirical evidence for its efficacy, and will also focus on teaching core interventions used in this approach that target couple communication patterns.

Learning Objectives:

  • For participants to understand the principles underlying contemporary BCT
  • An understanding of the empirical literature that supports the use of BCT
  • An understanding of the assessment and formulation strategies used in BCT
  • Procedural knowledge of the use of interventions that target couple communication patters
  • Procedural knowledge of how to use cognitive interventions in the context of couple work

Teaching methods:
Lecture, DVD and live demonstrations of key interventions, Small group experiential exercises with feedback

Workshop leaders:
Michael Worrell,PhD, BABCP accredited practitioner, supervisor and trainer, is a Consultant Clinical Psychologist and Director of Post Graduate Training Programmes in CBT for Central and North West London NHS Foundation Trust in collaboration with Royal Holloway University of London.

Sarah Corrie, DClin Psychol, BABCP accredited practitioner, supervisor and trainer, is a Consultant Clinical Psychologist and Visiting Professor at Middlesex University. She is Programme Director of the Postgraduate Diploma & MSc in Cognitive Behavioural Psychotherapy offered by Central and North West London Foundation Trust in collaboration with Royal Holloway University of London. Sarah is currently Chair of the Special Group in Coaching Psychology of the British Psychological Society.
Michael and Sarah have worked in collaboration with professor Don Baucom in delivering training in BCT to High Intensity Therapists as part of the National IAPT programme and have experience in both delivering BCT clinically as well as supervising others in BCT.

Key references:
Epstein, N., & Baucom, D. H. (2002). Enhanced cognitive-behavioral therapy for couples:  A contextual approach. Washington, DC: American Psychological Association.

Baucom, D. H., Shoham, V., Mueser, K. T., Daiuto, A. D., & Stickle, T. R. (1998). Empirically supported couples and family therapies for adult problems. Journal of Consulting and Clinical Psychology, 66, 53-88.