WORKSHOPS

PRE-CONFERENCE WORKSHOPS

Tuesday 21st July 2015.
9.30 am - 5.00pm

A programme of one-day workshops will be held on Tuesday 21st July. These workshops offer participants an opportunity to develop practical skills in the assessment and treatment of a range of problems.


  Tuesday 21st July
 

Cognitive Therapy for Social Anxiety Disorder in Adolescents

David Clark and Eleanor Leigh, The University of Oxford

Workshop 1 - Full details

Scientific background and description of workshop:
Social anxiety disorder (SAD) is a common and disabling anxiety disorder that has a particularly low natural recovery rate, so there is a real need for effective treatments.
Randomized controlled trials have shown that individual cognitive therapy (based on the Clark & Wells 1995 model) is highly effective in adults and compares favourably with other treatments (exposure therapy, group CBT, IPT, psychodynamic psychotherapy, SSRI’s, and pill placebo). However, SAD invariably starts in childhood or adolescence, and can severely interfere with school performance and social development. Ideally, effective treatment should therefore start in childhood, rather than waiting until adulthood. Unfortunately, the evidence base for adolescent treatments is weak (NICE, 2013) and there is some evidence that existing child focused CBT programmes benefit children with social anxiety disorder less than children with other anxiety disorders.
In response to this problem, we have experimented with adapting individual cognitive therapy (based on the Clark & Wells model) for use with adolescents. We have obtained excellent results in a small case series and will be exploring the approach further.
This workshop will outline the Clark & Wells model and illustrate the key treatment procedures that have been developed from the model. These include: the self-focused attention and safety behaviours experiential exercise, video-feedback, externally-focused attention training, behavioural experiments, and procedures (discrimination training and memory re-scripting) for addressing early experiences that influence patients’ current behaviour in social situations. Particular emphasis will be placed on how the techniques can be applied with adolescents and the key adaptations that are needed.

Key learning objectives:
1.            To be able to identify key processes in maintaining social anxiety disorder
2.            To be familiar with the main procedures in cognitive therapy for social anxiety disorder
3.            To learn about the key adaptations of cognitive therapy for social anxiety disorder with adolescents

Training modalities:
Role play
Video clips
Case material

References:
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.
Hodson, K.J., McManus, F.V., Clark, D.M., & Doll, H. (2008). Can Clark and Wells’ (1995) cognitive model of social phobia be applied young people? Behavioural and Cognitive Psychotherapy, 36, 449–461.
Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D.M.,  Ades, A., and Pilling S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. Lancet Psychiatry, 1: 368-376.
Layard, R. & Clark, D.M. (2014). Thrive: The Power of Evidenced-Based Psychological Therapies. London, UK: Penguin Press.

Implication for everyday clinical practice of CBT:
The session will provide the opportunity to learn about how a highly effective treatment for social anxiety disorder in adults can be applied with adolescents. Attendees will learn practical skills in how to do this. This workshop is likely to help clinicians in their work with socially anxious adolescents.

Brief description of workshop leaders:
David M Clark is Professor of Experimental Psychology at the University of Oxford. He is well-known for his pioneering work on the understanding and treatment of anxiety disorders. With colleagues, he has developed effective cognitive-behaviour therapy programmes for four different anxiety disorders: panic disorder, social anxiety disorder, post-traumatic stress disorder and health anxiety (hypochondriasis). He has also played a key role in disseminating evidence-based psychological treatments, including the IAPT programme.
Eleanor Leigh is a Senior Clinical Psychologist at the Anxiety & Traumatic Stress Clinic, National & Specialist CAMHS. She provides teaching, training and supervision in cognitive-behaviour therapy with children and adolescents, including the Children & Young People’s IAPT initiative. 


 

Using Empirical Findings on the Processes and Outcomes of CBT for Depression to Become a More Effective Therapist

Rob DeRubeis, University of Pennslyvania, USA

Workshop 2 - Full details

Research aimed at understanding how CBT for depression works has produced information that can help us deal effectively with the very different challenges our clients bring to us. Some findings, for example those that tell us that the therapeutic alliance is built upon the development of a shared understanding of the goals and tasks of therapy, accord with clinical intuition. Others – those that speak to the different foci that may be needed for patients who present with anxiety or personality disorder comorbidity – may be more surprising.

The workshop will use the research literature as background for a description of approaches that can lead to more powerful interventions with depressed clients. The focus throughout will be on clinical issues that are familiar to therapists, and discussions of the concepts will in each case be illustrated with case examples, role plays, or videotaped vignettes. Participants are encouraged to prepare brief descriptions of their most difficult cases and of challenges that arise commonly in their practices, with the goal of making the workshop lively and maximally relevant to their practices. 

Key learning objectives:
1. To understand the relevance of research on the therapeutic alliance to the practice of CBT for depression.
2. To appreciate what the literature on CBT for depression with comorbidities tells us about the most effective means of addressing common problems in therapy.
3. To see how a balance between rigor and flexibility leads to the most effective application CBT with depressed clients.

Training modalities:
Didactic presentation of clinically-relevant research findings
Descriptions of the application of CBT with clinical cases
Videotape vignettes
Role-plays with participants
Discussion of the questions raised by participants

2-3 key references:
Forand, N. R., & DeRubeis, R. J. (2014). Extreme response style and symptom return after depression treatment: The role of positive extreme responding. Journal of Consulting and Clinical Psychology, Feb 3, 2014. doi: 10.1037/a0035755
Strunk, D. R., DeRubeis R. J., Chiu, A. W., & Alvarez, J. (2007). Patients’ competence in and performance of cognitive therapy skills: Relation to the reduction of relapse risk following treatment for depression. Journal of Consulting and Clinical Psychology, 75, 523-530.
Webb, C. A., DeRubeis, R. J., Amsterdam, J. D., Shelton, R. C., Hollon, S. D., & Dimidjian, S. (2011). Two aspects of the therapeutic alliance: Differential relations with depressive symptom change. Journal of Consulting and Clinical Psychology, 79, 279-283.

Implication for everyday clinical practice of CBT:
As therapists, each of us is attuned to different cues that then affect what clinical decisions we make as we work with our patients. This workshop will introduce and elaborate upon cues that we as clinicians can use to guide our practice, including our decisions about when the client is ready to terminate therapy or reduce session frequency.

Brief description of workshop leader:
Thirty-five years ago Rob DeRubeis participated in a two-week workshop at the original Center for Cognitive Therapy, conducted by Aaron Beck and his colleagues. Since then Rob has been involved continuously as a cognitive therapist and cognitive therapy trainer and researcher. He has taught and supervised more than 75 doctoral students in cognitive therapy at the University of Pennsylvania, where he has been a member of the Psychology faculty since 1983. He has received several awards for his research on the processes and outcomes of cognitive therapy for severe, chronic, or recurrent depression, including the Academy of Cognitive Therapy’s Aaron T. Beck Award (2004) and the Senior Distinguished Career Award from the Society for Psychotherapy Research (2013).

In his workshops he uses videotape vignettes and role plays with audience participants to illustrate how to turn the greatest challenges therapists encounter in cognitive therapy sessions into the most impactful learning opportunities for our clients. He also emphasizes tools that ensure that patients can continue to be their own therapists after therapy ends.


 

Learning How to Feel Good: How to Build Positivity in Depressed Clients

Barney Dunn and Richard Moore, University of Exeter

Workshop 3 - Full details

Scientific background and description of workshop:
The primary focus in CBT for depression has been on down-regulating negative thinking and feeling. However, it is increasingly realised that anhedonia, a reduction in the ability to experience pleasure, is also central to the onset and maintenance of depression, particularly more chronic presentations. Augmenting positive emotional experience and positive information processing has received less attention in the CBT literature to date. There is increasing interest in the idea that anhedonia is central to mood disorders and should be more of a focus in treatment. This skills workshop will focus on ways to build positivity in CBT treatment, whilst minimising the possibility that a positive focus is perceived by clients as “PollyAnna-ish”. A mixture of training modalities will be used, including reviewing session tapes and role-play practice

Key learning objectives:

By the end of the class, participants will have learnt how to:
·         Identify and formulate mechanisms that maintain anhedonia
·         Identify and target ‘positive dampening’ appraisals and counterproductive emotion regulation strategies that block pleasure experience
·         Optimise use of existing CBT techniques (e.g. activity scheduling, positivity data logs) to build positivity
·         Minimise the likelihood that a positivity focus is perceived by clients as “PollyAnna-ish”

Training modalities
A mixture of training modalities will be used, including reviewing session tapes and role-play practice

2-3 key references
·         Dunn, B.D. (2012). Helping depressed clients reconnect to positive emotion experience: Current insights and future directions. Clinical Psychology & Psychotherapy, 19, 326-340.
·         Werner-Seidler, A., Banks, R., Dunn, B. D. & Moulds, M. L. (2013). An investigation of the relationship between positive affect regulation and depression. Behaviour Research and Therapy51, 46-56.

Implication for everyday clinical practice of CBT
Better targetting anhedonia is likely to lead to improved treatment outcomes when using CBT to treat depression.

Brief description of workshop leader(s)
Barnaby Dunn is a research and clinical psychologist, currently employed as an Associate Professor at the University of Exeter Mood Disorders Centre. He leads a research programme characterising positivity deficits in depression and developing novel ways to build positivity in CBT. From 2015 to 2020 his positivity research programme is funded by an NIHR Career Development Fellowship programme.  He has recently completed the Beck Scholar programme at the Beck Cognitive Therapy Institute in Philadelphia. He is BABCP accredited, was awarded diplomate membership of the Academy of Cognitive Therapy in 2013, and in his ongoing clinical practice treats anhedonic depressed clients (see: http://psychology.exeter.ac.uk/staff/index.php?web_id=Barney_Dunn).


 

Compassion Focused Therapy for Psychosis

Charlie Heriot-Maitland, King's College London,
Eleanor Longden, University of Liverpool, UK
Chris Irons, East London NHS Foundation Trust, UK

Workshop 4 - Full details

Scientific background and description of workshop:
Clinical observations of psychotic symptoms, such as paranoid beliefs and commanding voices, often signal underlying themes of threat, and research consistently shows that people with psychosis have biased recall of, and attention towards, threatening information. Psychological models have recognised the importance of threat processing in psychosis, characterising psychotic states as the manifestation of highly sensitised, overstimulated, threat-response systems (Gumley, Braehler, Laithwaite, MacBeth, & Gilbert, 2010). There are two key aspects to the threat in psychosis. One is posed by the potential external threat from others through shaming, stigmatising, excluding, and also from the (potential) persecution from others. The second source of threat is an internal one, generated by the negative, critical and hostile content of voices and self-evaluation (Birchwood et al., 2004; Birchwood, Meaden, Trower, Gilbert, & Plaistow, 2000). Experiences of both internal and external threat will similarly orientate, through evolutionary processes, an individual’s information processing and behaviour towards the motive of self-protection, activating automatic safety responses such as avoidance and dissociation. Compassion-Focused Therapy (CFT) aims to help people regulate threat processing by building internal feelings of safeness and affiliation, and by providing contexts, practices and insights that facilitate the development of compassion to self, others, and dissociated parts. Early evidence for the usefulness of applying the CFT approach in psychosis populations is beginning to emerge (Braehler et al., 2013; Laithwaite et al., 2009; Mayhew & Gilbert, 2008).

This workshop will train participants in how to orientate their CBT interventions for people with psychosis towards the process of developing compassion, in line with CFT aims. The claim is that existing CBT for psychosis techniques may become more useful and effective when applied within a compassion-orientated framework, because the compassionate mind provides a secure base and grounding from which to approach difficult (and dissociated) emotions, memories, voices, etc. Also, the process of building capacity in the affiliative system may help to calm threat processing, thereby making the interventions more accessible and tolerable to clients with psychosis. Workshop participants will be introduced to the CFT model of compassion, learn how to apply this model in psychosis, and how to formulate psychosis-related difficulties in terms of threat- and shame-based processes. Participants will then learn how to focus CFT and CBT skills towards cultivating compassion in people with psychosis.  

Key Learning Objectives:
Participants will be able to:

  • Understand the CFT model of compassion, and its relevance for people with psychosis
  • Help their clients through five key stages of a CFT for psychosis intervention:
    • Establishing safeness and connection
    • Psycho-education about evolved brains, emotion systems, and multiple selves
    • Threat-based formulation and 3 circles formulation
    • Cultivate / deepen the compassionate self
    • Direct compassion to others, self, dissociated parts/voices

Training Modalities (ie experiential, didactic, role play etc):
Slides / didactic teaching; clinical case material; personal experiential exercise; small group exercise; role play exercise

2 - 3 Key References:
Braehler, C., Gumley, A.I., Harper, J. et al. (2013). Exploring change processes in compassion focused therapy in psychosis: results of a feasibility randomized controlled trial. British Journal of Clinical Psychology, 52(2), 199-214.

Gumley, A., Braehler, C., Laithwaite, H. et al. (2010). A compassion focussed model of recovery after psychosis. International Journal of Cognitive Psychotherapy, 3(2), 186-201.

Mayhew, S. & Gilbert, P. (2008). Compassionate mind training with people who hear malevolent voices: A case series report. Clinical Psychology and Psychotherapy, 15, 113-138.

Implications for the everyday clinical practice of CBT:
Participants will learn how to orientate existing CBT for psychosis techniques towards the process of cultivating compassion for self and others, within a CFT framework.

Brief Description of the Workshop Leaders:

Dr Charlie Heriot-Maitland is a clinical psychologist who provides CFT for people with psychosis in NHS services and runs CFT training for various staff groups. He is also researching the application of CFT in psychosis for an MRC Fellowship award.

Dr Eleanor Longden is a research psychologist with lived experience of psychosis who has lectured internationally on recovery-orientated approaches to complex mental health problems, including TED and WHO events. She coordinates the research committee of Intervoice.

Dr Chris Irons is a clinical psychologist who, alongside Paul Gilbert and others, has been involved in the development of CFT. He provides CFT training internationally and is a board member of the Compassionate Mind Foundation.


 

Implementig Cognitive Therapy for Bipolar Disorder in practice: How to enhance personal recovery outcomes

Steve Jones, University of Lancaster
Fiona Lobban, University of Lancaster
Elizabeth Tyler,
University of Lancaster

Workshop 5 - Full details

Scientific background and description of workshop:
The recent NICE guidelines have made a series of recommendations for the role of psychological interventions in bipolar disorder. In addition NICE have also indicated some key gaps in the current literature which require urgent attention. This includes moving beyond a traditional focus on relapse prevention alone to broader consideration of functional and recovery focused outcomes. The workshop will present new developments in therapy research from the Spectrum Centre with a particular focus on recovery focused CBT (RfCBT) 

Key learning objectives:
1. Be aware of current NICE guidelines for psychological therapy for bipolar disorder and recommendations for further research
2. Be aware of recent research into psychological and family processes in bipolar disorder
3.  Identify key targets in recovery focussed CBT for bipolar disorder
3. Know a range of techniques for improving recovery outcomes in bipolar disorder.

Training modalities
The workshop will consist of didactic teaching, discussion, video excerpts, role-play, and small group exercises

2-3 key references
Jones, S. H., Smith, G., Mulligan, L., Lobban, F., Law, H., Dunn, G., Welford, M., Kelly, J., Mulligan, J., Morrison, A. (2014). Recovery focused CBT for individuals with recent onset bipolar disorder: A randomised controlled pilot trial. British Journal of Psychiatry,  doi:10.1192/bjp.bp.113.141259
Jones, S. H., Lobban, F., Cooke, A. et al. (2010). Understanding bipolar disorder: Why some people experience extreme mood states and what can help. British Psychological Society: Leicester.
Lobban, F., Taylor, K., Murray, C., Jones, S. (2012). Bipolar Disorder is a two-edged sword- A qualitative investigation into the positive edge. Journal of Affective Disorders, 141, 204-212
National Institute of Clinical Excellence (2014) Bipolar disorder: the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care: Clinical Guidelines CG185.

Implication for everyday clinical practice of CBT
The workshop will highlight how CBT for bipolar disorder is evolving towards an individualised formulation-based approach which, rather than presuming that relapse into mania and depression are primary outcomes, considering the importance of movement towards personal recovery goals.

Brief description of workshop leader(s)
Steven Jones and Fiona Lobban are both Professors of Clinical Psychology and Co-Directors of the Spectrum Centre for Mental Health Research at Lancaster University. Elizabeth Tyler is also based at the Spectrum Centre and is an NIHR Doctoral Research Fellow. Steven was a GDG member for the recent update of NICE Clinical Guidelines for Bipolar Disorder and is expert lead for Bipolar Disorder for the IAPT SMI project. He has published widely on the psychology and psychological therapy of bipolar disorder include a number of books (Coping with Bipolar Disorder (2003), The Psychology of Bipolar Disorder (2006) and Cognitive Therapy for Bipolar Disorder (2010). Fiona was BABCP stakeholder representative for the NICE Clinical Guidelines for Bipolar Disorder and is a member of the IAPT SMI Education and Training task group. Fiona has published extensively on psychological models and treatment of bipolar disorder and severe mental illness more broadly, including A Casebook of Family Interventions for Psychosis (2009).  Through their work at the Spectrum Centre they have 7 RCTs of novel interventions for bipolar disorder either completed or in progress. Elizabeth has extensive experience as a trial therapist including in the delivery of recovery focussed CBT. Her current research is exploring how this approach might be applied in older adults. She has also had a key role in coordinating the IAPT SMI demonstration site for bipolar disorder.


 

Targeting the self in the cognitive-behavioural treatment of OCD 

Mike Kyrios, Australian National University

Workshop 6 - Full details

Scientific background and description of workshop:
Obsessive Compulsive Disorder (OCD) is a complex but common and highly disabling disorder associated with high degrees of comorbidity that presents throughout the lifespan. Cognitive and behavioural conceptualizations of OCD have led to effective psychological treatments, and are recommended by various guidelines as first-line treatments (e.g., National Institute of Clinical Excellence). Exposure and response prevention (ERP), cognitive therapy (CT) and their combinations in the form of cognitive-behaviour therapy (CBT) have been applied in individual, group and bibliotherapy modalities with or without pharmacological treatments. While the outcome literature supports the efficacy of CBT, outcomes can vary with recovery rates of only around 40% - 50% when one considers dropout, relapse and non-response rates (McKay et al., 2015). Furthermore, the dissemination of these treatments is hampered by a number of obstacles including the lack of an adequately trained specialist workforce, geographic remoteness from a trained workforce and consumer reticence to present for treatment.

In response, researchers have sought to develop new modalities for the dissemination of CBT using digital technologies. In addition, research has turned to identifying factors predictive of poorer outcomes, and the subsequent development of augmented or novel treatment strategies based on new theoretical approaches that extend the traditional cognitive-behavioural model of OCD.
Our most recent research has focused on the association between OCD phenomena and self constructs such as ambivalence about one’s self-worth, perceptions about the importance of the moral domain in establishing one’s self-worth, and dissonance between implicit and explicit self-worth. On the basis of findings about the relevance of these self-based constructs, this workshop presents a conceptual model of OCD where concerns about transgressions in the moral domain and their impact on self concept are prominent. The conceptual model incorporates cognitive, self-construal, mood and behavioural factors, and has direct implications for engagement with affected individuals and their treatment.

Following on from this model, traditional cognitive-behaviour therapy for OCD can be enhanced by incorporating interventions that target self-concept. The first half of this full-day workshop will draw on cognitive-behavioural, attachment and self-related concepts to develop a conceptual framework for understanding strategies to engage and treat individuals with OCD. Case examples will be used to illustrate key points, and to compare traditional and revised conceptualizations of specific cases. Self-based strategies from a range of frameworks will be overviewed in the second half of the workshop. We will then go on to “workshop” difficult cases using these augmented self-based management/treatment strategies. Workshop attendees are asked to bring at least one such case to the workshop. Notes will be made available, and additional references and resource material will be suggested.

Key learning objectives:

  1. Understand the cognitive-behavioural framework of OCD and its limitations
  2. Understand the range of self constructs that can be used to further understand vulnerabilities to OCD cognitions and symptoms
  3. Develop case formulations for OCD cases that incorporate self constructs
  4. Develop engagement and intervention strategies to facilitate treatment of OCD
  5. Learn to integrate self-based conceptualisations into cognitive-behavioural treatment formulations

Training modalities

  1. Cognitive-behaviour therapy
  2. Self-based strategies using attachment and psychodynamic, narrative, Acceptance and Commitment Therapy, and metacognitive conceptualisations

Key references

  1. Bhar, S. & Kyrios, M. (2007) An investigation of self-ambivalence in Obsessive-Compulsive Disorder. Behaviour Research & Therapy, 45, 1845–1857.
  2. Doron, G. & Kyrios, M. (2005). Obsessive Compulsive Disorder: A review of possible specific internal representations within a broader cognitive theory. Clinical Psychology Review, 25, 415–432.
  3. Kempke, S. & Luyten, P. (2007). Psychodynamic and cognitive-behavioral approaches of obsessive-compulsive disorder: Is it time to work through our ambivalence? Bulletin of the Menninger Clinic, 71, 291-311 
  4. Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research & Therapy, 35, 793-802

Implication for everyday clinical practice of CBT
Given the complexities and limitations associated with managing clients with OCD, practitioners often need additional conceptual frameworks and skills to improve engagement and outcomes related to psychological treatment. This workshop will provide practitioners with a broader range of case and treatment formulation skills in managing OCD.

Brief description of workshop leader:
Professor Michael Kyrios is an academic and clinical psychologist and is currently Director of the Research School of Psychology at the Australian National University. Throughout his career, he has undertaken a range of academic, practice, professional & administrative roles. He was the senior clinical psychologist at the Royal Melbourne Hospital for over a decade, and has previously held major academic posts at the University of Melbourne and Swinburne University of Technology where he was Director of the Brain & Psychological Sciences Research Centre and the National e-Therapy Centre. Professor Kyrios is the current President of the Australian Psychological Society (APS), having been elected a Fellow in 2007.

Professor Kyrios’ research focuses on obsessive-compulsive spectrum disorders (OCD, hoarding disorder, body dysmorphic disorder, trichotillomania), behavioural addictions (compulsive buying, problem gambling), anxiety disorders, depression, chronic medical illness, and the development, evaluation and dissemination of evidence-based psychological treatments, including e-therapies. His research and conceptual frameworks encompass behavioural, cognitive, neuropsychological and developmental methodologies. More recently, he has used self-based conceptualisations to understand psychopathology, particularly obsessive-compulsive and related disorders. He is lead editor of two special editions (for Psychopathology and Australian Psychologist) and a book (for Cambridge University Press to be published in 2016) on the self in psychological disorders.

 

Radically Open-Dialectical Behaviour Therapy (RO-DBT) – for Disorders of Overcontrol

Thomas Lynch, University of Southampton

Workshop 7 - Full details

Self-control, the ability to inhibit competing urges, impulses, or behaviours is highly valued by most societies. However, excessive self-control has been linked to social isolation, aloof interpersonal functioning, maladaptive perfectionism, inhibited expressions, and difficult-to-treat mental health problems, such as anorexia nervosa, obsessive compulsive personality disorder and refractory depression. Based on 20 years of research, two NIMH funded randomized controlled trials (RCTs) targeting depression and overcontrolled personality disorders, an open-trial with adult anorexia nervosa, and a large ongoing multi-site RCT (http://www.reframed.org.uk) the aim of this workshop is to introduce clinicians to new theory and strategies underlying Radically Open-Dialectical Behaviour Therapy (RO-DBT) for disorders of overcontrol (treatment manual pending; Guilford Press).  

RO-DBT posits emotional loneliness as the core problem underlying maladaptive overcontrol. Heightened threat sensitivity and diminished reward sensitivity are hypothesized to transact with early family experiences emphasizing “mistakes intolerable” and “self-control imperative” to produce overcontrolled coping.  A novel thesis linking the communicative functions of emotional expression to the formation of close social bonds will be introduced, as well as new skills emphasizing receptivity, self-enquiry and flexible responding. New approaches to activate a neurobiologically-based social-safety system, signal cooperation, enhance forgiveness, and change envy/bitterness will be introduced; using videos and role play.

Objectives: Participants will be able to…
1.             Explain the biosocial theory for overcontrol (OC) and recognize core differences between undercontrol and overcontrol.
2.             Describe the RO-DBT treatment hierarchy and the five OC behavioural themes.
3.             Describe the importance of activating a neural substrate associated with the ventral vagal complex and social-safety when working with OC.
4.             Demonstrate non-verbal strategies to repair therapeutic-alliance ruptures and articulate how open expression enhances intimate relationships.
5.             Define radical openness and practice self-enquiry to enhance learning from disconfirming or unexpected feedback.

Modalities: Instruction, Modelling, Videos, Role-Plays

References: 1.   Lynch, T.R., Gray, K.L.H., Hempel, R.J., Titley, M., Chen, E.Y., O’Mahen, H.A. (2013) Radically Open-Dialectical Behavior Therapy for adult Anorexia Nervosa: Feasibility and outcomes from an inpatient program; BMC Psychiatry, 13; 293
2.             Lynch, T. R., & Cheavens, J. S. (2008). Dialectical behavior therapy for comorbid personality disorders. Journal of Clinical Psychology, 64(2), 154-167.
3.             Lynch, T. R., Cheavens, J. S., Cukrowicz, K. C., Thorp. S., Bronner, L., & Beyer, J. (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.

Leaders: Thomas Lynch, Ph.D is Professor of Clinical Psychology and Director of the Emotion and Personality Biobehavioural Laboratory in the School of Psychology at the University of Southampton. He is considered a senior DBT researcher and trainer, and is principal investigator on large clinical trials, such as a multi-site study of DBT for BPD with opiate dependence (Linehan & Lynch) and a multi-centre study of RO-DBT on-going in the UK—Project REFRAMED.  He is a recipient of the John M. Rhoades Psychotherapy Research Endowment, is a Beck Institute Scholar, and is a Grandfathered Fellow in the Academy of Cognitive Therapy.

Implications: Until recently, the majority of treatment interventions targeting personality disorders (PDs), including CBT and standard DBT, have tended to target borderline personality disorder (BPD)—a disorder characterized by low inhibitory control and dysregulated/impulsive behavior (see Dixon-Gordon, Turner, & Chapman, 2011 for review). In contrast, Radically Open-Dialectical Behavior Therapy (RO-DBT), a new treatment approach with strong roots in standard DBT, targets a spectrum of disorders and PDs that share genotypic and phenotypic features linked to excessive self-control or overcontrol (T. R. Lynch, in press; T. R. Lynch & Cheavens, 2008; T. R. Lynch et al., 2013).
Understanding a person’s characteristic style of self-control can make a big difference when planning treatment strategies and may help explain why treatment responses vary considerably among those receiving the same intervention. While it is impossible or difficult to alter genetic/biological predispositions and/or past experiences, it is possible to improve self-regulation. Thus, targeting self-control tendencies as a focus in treatment provides an important means for introducing therapeutic change. This perspective has clear treatment implications; (i) treatments should not assume client capabilities for openness and flexible responding already exist, emphasizing the need for skills-based approaches, and (ii) undercontrolled problems require interventions designed to enhance constraint or inhibitory control; whereas overcontrolled problems require interventions designed to relax rigid inhibitory control and increase emotional expressiveness, receptivity, and flexibility.


 

Anger Dysregulation: Assessment, Case Formulation, and Treatment

Ray Novaco, University of California and
John Taylor, University of Northumbria

Workshop 8 - Full details

Anger dysregulation occurs in various personality, psychosomatic, and conduct disorders, in schizophrenia, in bipolar mood disorders, in organic brain disorders, in impulse control dysfunctions, in disorders resulting from trauma, and it is the emotional driver of challenging behaviour for persons with intellectual disabilities. Anger treatment should be grounded in assessment of anger control deficits and be case formulated.  Substantial validity and utility for a multi-modal approach to the assessment of anger among clients, including those having intellectual disabilities, has been obtained in clinical research, as interfaced with anger treatment. Psychometric, staff-rated, and interview methods of assessment will be presented.  Case formulation will be practised using an anger dysregulation model.  Our CBT stress inoculation approach to anger treatment will be illustrated and fundamentals of the approach will be demonstrated and practised for use in anger treatment sessions.

Key learning objectives

1.  Familiarity with anger self-report and staff-rated psychometric instruments and their clinical use
2.  Ability to implement client self-monitoring procedures
3.  Use of an imaginal provocation test for anger to assess treatment gains
4.  Ability to do case formulation from anger assessment and anger dysregulation model
5.  Understanding cognitive restructuring, arousal reduction, & behavioural skills therapy components
6.  Proficiency in provocation hierarchy procedures in stress inoculation format
7.  Familiarity with treatment outcome evaluation procedures

Key references
Novaco, R. W., & Taylor, J. L.  (2015). Reduction of assaultive behavior following anger treatment of
forensic hospital patients with intellectual disabilities. Behaviour Research & Therapy, 65, 52-59.
Novaco, R. W. (2010).  Anger and psychopathology. In M. Potegal, G. Stemmler, & C. Spielberger (Eds.). Handbook of anger (pp. 465-497).  New York: Springer.
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.


 

The Maudsley Model of Anorexia Treatment for Adults (MANTRA): An Introduction to Model, Evidence and Treatment Skills

Ulrike Schmidt, King’s College, London

Workshop 9 - Full details

 

Scientific background and description of workshop:

Anorexia nervosa (AN) is a highly distinctive disorder at the brain-body interface. Whilst therapeutically ‘malleable’ early on, once established it is remarkably persistent. Psychological treatments for adults with AN have had limited efficacy. Some years ago, we proposed a maintenance model of AN (The Maudsley Model of Anorexia Treatment for adults, MANTRA), refined in an iterative experimental and translational process. Treatment targets are key maintaining factors, including [a] a thinking style characterised by rigidity, detail focus and fear of making mistakes, [b] an in-expressive avoidant emotional and relational style, [c] positive beliefs about the utility of anorexia for the person, and [d] a response of close others characterised by high expressed emotion and enabling of and accommodation to the illness. These maintaining factors are addressed in the context of the patient’s underlying temperament. Recent research evidence suggests that AN patients prefer MANTRA to gold-standard comparison treatment and that those with a more severe illness make a better recovery with this treatment.

Key learning objectives:

(1) Participants will learn to identify unique features of MANTRA, together with their empirical and theoretical underpinnings. 

(2) Participants will  become familiar with key treatment strategies of MANTRA during the initial and later phases of treatment.

(3) Participants will learn how to develop a collaborative case conceptualisation for people with AN, and the different formats for such formulations that might be most helpful.

(4) Participants will learn how to include close others in treatment. 

Training modalities

A mixture of didactic and experiential techniques will be used, the latter includes role play, small-group and individual guided experiential exercises to practice interventions.

 

 

Key references

Schmidt U, Treasure J. (2006). Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. Br J Clin Psychol. 45: 343-66.

Treasure, J., & Schmidt, U. (2013). The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. Journal of Eating Disorders,1,13.

Schmidt, U., Wade, T.D., & Treasure, J. (2014). The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): Development, Key Features and Preliminary Evidence.  Journal of  Cognitive Psychotherapy, 28, 48-71. 

Implication for everyday clinical practice of CBT

Many of the strategies used in MANTRA in the treatment of AN are highly applicable to other eating disorders, but also to other problems which are ego-syntonic and where there is limited motivation for change.

Brief description of workshop leader(s)

Ulrike Schmidt is Professor of Eating Disorders at the Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK and a consultant psychiatrist at the Eating Disorders Service at the South London and Maudsley NHS Foundation Trust (SLaM). Her research interests cover all aspects of eating disorders, with a key focus of her research on experimental therapeutics, i.e. development of interventions as probes of disease mechanisms as well as tests of efficacy. This work has included development of brief scalable psychological treatments and preventative interventions for eating disorders and use of novel ‘brain-directed treatments’, such as non-invasive neuromodulation approaches. 


 

CBT for Common Trauma Responses in Routine Practice

Mike Scott, Private Practice

Workshop 10 - Full details

Scientific background and description of workshop:

This workshop focuses on the CBT treatment of dramatic debility post trauma, including common sequelae such as PTSD, but also less common consequences such as body dysmorphic disorder. Real world cases are often complicated by pain and disfigurement and these added difficulties will also be addressed. Treatment follows from a cognitive assessment of each of the disorders present. A DSM-5 based cognitive model of PTSD will be presented in which it is suggested that the signature of the disorder is a state of terrified surprise.  A Survival Manual based on the model will be made available. In routine practise trauma focussed CBT (TFCBT) is sometimes outside of the comfort zone of a client and the therapist.  An alternative coping skills approach is described which can act as a catalyst for TFCBT and may suffice. Finally participants will have the opportunity to discuss and role play difficult cases and adaptations needed for special populations e.g children, people with learning difficulties and psychosis.

Key learning objectives:

1. To appreciate the need for a cognitive assessment of all disorders/difficulties present

2. To understand that a comprehensive cognitive assessment is the foundation for case formulation and that without it the latter may be a poor guide to efficacious treatment

3. To familiarise participants with a DSM-5 based cognitive model of PTSD.

4. To recognise that not all clients find trauma focussed CBT acceptable and that where this is the case a coping skills approach can be used which sometimes may suffice or act as a catalyst for a TFCBT

5. To appreciate the adaptations to established protocols that are often needed to tailor treatment to the individual.

6. To appreciate the strengths and limits of trauma self-help material.
Training modalities

Role plays and video

2-3 key references

1. Scott, M.J (2013) CBT for Common Trauma Response London: Sage

2. Scott, M.J (2008) Moving on After Trauma London: Routledge

3. Scott, M.J (2015) Traumatic Stress. 4 Volume edited work London: Sage

 

Implication for everyday clinical practice of CBT

This workshop will enable practitioners to ensure fidelity to evidence based CBT protocols for debility post trauma whilst ensuring sufficient flexibility to tailor treatment to the needs of the individual.

Brief description of workshop leader(s)

Dr Scott specialises in the assessment and treatment of patients following trauma. He is the editor of a just published four volume work on ‘Traumatic Stress’ (Sage Publications), containing 86 papers by the leading international psychologists and psychiatrists in the field. Dr Scott has written ten books relating to the cognitive behavioural treatment of depression and anxiety disorders, most recently ‘Simply Effective CBT Supervision’  published by Routledge  (2013) others include ‘Simply Effective Group Cognitive Behaviour Therapy’ (2011) Routledge and ‘Simply Effective Cognitive Behaviour Therapy’ (2009). In addition he has authored book chapters including ‘CBT in Health and Social Care Settings’  (2011) in The Handbook of CBT Ed W. Dryden and R. Branch Sage Publications and papers on variously  depression and child behaviour problems.


 

Imagery and the Self: Understanding How Imagery Maintains Negative Self-Views and How You Can Use Imagery to Change Them

Lusia Stopa, Southampton University

Workshop 11 - Full details

Scientific background and description of workshop:
Intrusive images are present in many disorders. They are often repetitive and uncontrollable, and act as emotional amplifiers in a number of models of psychopathology (Stopa, 2009). Holmes and Mathews (2010) argued that images trigger affective responses through direct influence on the brain's emotional systems, through use of the same neural structures as perception, and through the activation of autobiographical memories. Autobiographical memories provide a data bank of information about the self; about who we are and how we see ourselves. Understanding the link between memory and self-perception is important because distorted self-perceptions are at the heart of many disorders and negative self-images often encapsulate the individual's negative beliefs (see Stopa, 2009, for a review). Negative self-images often derive from experiences such as neglect, abuse, bullying, and abandonment (Hinrichsen, Morrison,Waller, & Schmidt, 2007; Patel, Brewin, Wheatley, Wells, & Myers, 2007; Wells & Hackmann, 1993), and then help to maintain a vicious cycle of self-criticism, behavioral change (e.g.,avoidance, withdrawal), and disturbing physiological and emotional responses.

This workshop focuses specifically on self-imagery and will look in detail at how distorted self-images develop and are maintained and at various ways of using imagery to change distorted views of self. These techniques will include using video feedback, drawing on positive autobiographical memories to access more functional, positive views of self, and imagery rescripting.

Key learning objectives:
By the end of this workshop you should:

  1. Understand how imagery maintains negative self-views across a range of disorders
  2. Be familiar with a range of imagery intervention techniques that can be used to change negative views of self
  3. Have practised using some of these interventions in role plays
  4. Know how these imagery interventions can be combined with more traditional cognitive therapy intervention techniques

Training modalities

  1. Lecture
  2. Demonstration
  3. Experiential including imagery exercises and role play
  4. Discussion 

2-3 key references
Arntz, A.  (2011) Imagery rescripting for personality disorders. Cognitive and Behavioural Practice, 18, 466-481.
Stopa, L. (2009). Imagery and the threatened self: Perspectives on mental imagery and the self in cognitive therapy. East Sussex: Routledge.

Implication for everyday clinical practice of CBT
Imagery interventions offer powerful tools for cognitive therapists. However, many therapists do not regularly assess for images or use imagery in their current clinical practice. By the end of this workshop participants will have increased their knowledge of the role of imagery, and in particular, they will have looked in detail at the ways in which self-imagery can maintain negative views of the self. They will also have had a chance to practise imagery techniques so that they will feel more confident about incorporating them into their interventions.

Brief description of workshop leader(s)
Dr Lusia Stopa is Director of the Clinical Psychology Doctorate and strategic lead for Cognitive Therapy Programmes in the Psychology Department at the University of Southampton. She has an honorary Consultant Clinical Psychologist post with Southern Health Foundation NHS Trust and has been researching, teaching, and practising cognitive therapy for over twenty years. She is currently working on a practical book of imagery techniques for therapists, which will be published by Guilford Press.


 

Treating Clinical Perfectionism

Tracey Wade, Flinders University, Australia and
Roz Shafran, University College, London

Workshop 12 - Full details

Scientific background and description of workshop:
Generally in society perfectionism is thought to be a positive characteristic, involving striving to achieve high standards without experiencing negative consequences.  However clinicians are aware that aspects of perfectionism can be associated with negative consequences, leading to a range of problems like anxiety, depression and eating disorders.

This workshop will focus on a model of “clinical perfectionism” which describes people who set extremely high standards for performance, are very concerned with making mistakes, and base self-evaluation on how well these standards are met. 
This practical workshop will provide information on assessment and collaborative case formulation and therapeutic pitfalls to avoid with this population, as well as presenting a range of specific cognitive behavioural techniques that can be incorporated into an individualized treatment plan. This treatment is evidence-based and has been found to not only reduce perfectionism, but also reduce a range of psychopathology despite the symptoms not being targeted directly in treatment. As such, the approach outlined is appropriate for many clients seen in clinical practice who have elevated perfectionism and a range of different disorders. 

Key learning objectives:

  1. To understand the cognitive-behavioural analysis of clinical perfectionism and the factors that contribute to its maintenance
  2. To be aware of the relevant research literature and current evidence-base for the intervention.
  3. To learn how to assess clinical perfectionism and determine when it may warrant a specific intervention
  4. To be familiar with the cognitive-behavioural strategies used to address clinical perfectionism
  5. To be able to apply the intervention flexibly in accordance with different clinical presentations

Training modalities

  1. Didactic presentation
  2. Role plays
  3. Behavioural experiments
  4. Small group exercises
  5. DVD examples of therapy with this client group

2-3 key references

  1. Shafran R, Egan SJ, & Wade TD. (2010). Overcoming Perfectionism. Constable Robinson.
  2. Egan SJ, Wade TD, Shafran R, & Antony MM. (2014). Cognitive-Behavioral Treatment of Perfectionism. New York: Guilford Press.
  3. Lloyd, S., Schmidt, U., Khondoker, M., & Tchanturia, K. (2014). Can Psychological Interventions Reduce Perfectionism? A systematic review and meta-analyis. Behavioural and Cognitive Psychotherapy. DOI: 10.13140/2.1.3134.5281

Implication for everyday clinical practice of CBT
This workshop is appropriate for clinicians from a range of professions, and will be useful for the beginning level clinician and those enrolled in graduate training programs, through to clinicians with many years of experience who may struggle with a lack of available guidance in the treatment literature about how to approach the numerous clients they see where perfectionism is a large part of the presenting problem. 

Brief description of workshop leaders
Professor Tracey Wade has worked as a clinician in the area of eating disorders for over 20 years and is a member of the Steering Committee of the National Eating Disorder Collaboration in Australia. In 2000 she was awarded the Ian M Campbell memorial prize for outstanding contribution to the scientific or professional status of Clinical Psychology in Australia and in 2003 she was awarded the APS Early Career Award. Her research interests are in the aetiology, prevention and treatment of eating disorders, including the contribution of both genetic and environmental risk factors to risk. She has published over 130 peer-reviewed scientific articles, some of which address the relationship between perfectionism and psychopathology in terms of both prevention and treatment.

Professor Roz Shafran, Ph.D., Clin Psychol is an accredited CBT therapist and holds a Chair in Translational Psychology at the UCL Institute of Child Health. She is associate editor of Behaviour Research and Therapy and scientific co-chair of the British Association of Behavioural and Cognitive Psychotherapies. She is the founder and former Director of the Charlie Waller Institute of Evidence-Based Psychological Treatment. In 2011 she won the award for Distinguished Contributions to Professional Psychology from the British Psychological Society and the Marsh Award for Mental Health work. Her clinical research interests include cognitive behavioural theories and treatments for eating disorders, obsessive compulsive disorder and perfectionism across the age range. More recently, her research has addressed the dissemination and implementation of evidence based psychological therapies. She has published over 100 peer-reviewed scientific articles and books, including 'Overcoming Perfectionism' with Tracey Wade and Sarah Egan.