PRE-CONFERENCE WORKSHOPS

Tuesday 25th July 2017.
9.30 am - 5.00pm

A programme of one-day workshops will be held on Tuesday 25th July. These workshops offer participants an opportunity to develop practical skills in the assessment and treatment of a range of problems.


 

Imagery Rescripting: a transdiagnostic technique to address problems related to traumatic and other negative experiences

Arnoud Arntz, University of Amsterdam

Workshop - More information...

In Imagery Rescripting the meaning of the memory representation of a traumatic (or otherwise negative) event is changed by having the patient imagine as lively as possible a different outcome that meets the needs of the patient better. Imagery Rescripting is a powerful technique with empirical evidence for its effectiveness across disorders. It can be integrated in various forms of psychotherapy, or used as a complete treatment. Imagery Rescripting can be applied to memories of events that really happened in the past, but also to imagined events (like in nightmares, or feared future catastrophes). Although it is often applied when patients report intrusions (esp. of a visual kind), the technique can also successfully applied to change the meaning of experiences that contributed to dysfunctional schemas. Although its name suggests that the original memory representation is erased, research indicates that this is not the case. Rather, it seems the meaning of the memory (and not the memory of facts) that is changed.

The workshop will focus on the generic use of Imagery Rescripting, so that participants can use the technique in a variety of clinical problems, including PTSD, social phobia, chronic depression, and personality disorders. The basic protocol will be introduced, with both the therapist changing the script, and the patient from an observer perspective changing the script. Methods to increase the impact on the original memory representation, especially when it comes to (traumatic) childhood experiences will be discussed. Other issues that will be treated include when to start the rescripting, that full reliving of trauma memories is unnecessary, and dealing with problems like dissociation.

The workshop will be active, that is participants will practice techniques in pairs while support is provided; and there will be an interactive part where participants can raise questions and bring in specific cases.

In Imagery Rescripting the meaning of the memory representation of a traumatic (or otherwise negative) event is changed by having the patient imagine as lively as possible a different outcome that meets the needs of the patient better. Imagery Rescripting is a powerful technique with empirical evidence for its effectiveness across disorders. It can be integrated in various forms of psychotherapy, or used as a complete treatment. Imagery Rescripting can be applied to memories of events that really happened in the past, but also to imagined events (like in nightmares, or feared future catastrophes). Although it is often applied when patients report intrusions (esp. of a visual kind), the technique can also successfully applied to change the meaning of experiences that contributed to dysfunctional schemas. Although its name suggests that the original memory representation is erased, research indicates that this is not the case. Rather, it seems the meaning of the memory (and not the memory of facts) that is changed.

The workshop will focus on the generic use of Imagery Rescripting, so that participants can use the technique in a variety of clinical problems, including PTSD, social phobia, chronic depression, and personality disorders. The basic protocol will be introduced, with both the therapist changing the script, and the patient from an observer perspective changing the script. Methods to increase the impact on the original memory representation, especially when it comes to (traumatic) childhood experiences will be discussed. Other issues that will be treated include when to start the rescripting, that full reliving of trauma memories is unnecessary, and dealing with problems like dissociation.

The workshop will be active, that is participants will practice techniques in pairs while support is provided; and there will be an interactive part where participants can raise questions and bring in specific cases.


 

Difficult-to-treat depression:  an integrated approach

Stephen Barton, Newcastle University

Workshop - More information...

Scientific background and description of workshop:
The aim of this workshop is to support and energize CBT therapists working with difficult cases of depression.  Evidence suggests approximately 40% of patients with major depression will drop out or not gain significant benefit from CBT - this translates into significant numbers across the health service.  These patients are sometimes called “treatment-resistant” or, more accurately, treatment failures.  Therapists’ enthusiasm can be sapped dwelling on failures, so our attention tends to be diverted elsewhere (including when choosing training workshops!).  Consequently, we learn less from failures than might otherwise be the case.  This is ironic because as CBT therapists we know there is a lot to be learned from reflecting constructively on mistakes and challenges.
This workshop will tackle head-on some of the key challenges working with difficult-to-treat cases to help therapists learn new ways of responding.  It will use an integrated CBT model (developed by the Newcastle group) that draws on a range of cognitive and behavioural therapies, models and evidence. (It’s an integration of various CBT approaches, not other schools of therapy.)  The workshop will explore four common challenges working with difficult-to-treat cases.  The overall aim it not to suggest these challenges are easy, but to use the integrated model to understand specific difficulties and learn new ways of responding. 

Key learning objectives:
1.   Lack of motivation to change.  Although depression causes great suffering and hardship some patients appear unmotivated to change or improve their mood.  The workshop will explore different underlying reasons and ways to respond, including: the change rationale, balance of responsibility, therapeutic persuasion, approach and avoidance goals, future-directed cognition, calibration of therapy tasks, intolerance of uncertainty
2.  Depressive realism.  Events in the patient's life such as trauma, abuse or neglect make it understandable they've become depressed and when adversity and misfortune is extreme it can be difficult for the patient (and therapist) to have hope in recovery.  The workshop will stress the importance of differentiating depressed mood (which is normal and inevitable in some situations) from a major depressive disorder (which is not inevitable, even in extreme misfortune).  Hence the need to carefully target cognitive and behavioural maintenance processes, not just attend to the adverse situation.
3.  Recurrent and chronic depression.  Some patients have been stuck in persistent depression for several years or had multiple previous episodes and don’t stay well for long before relapsing.  As depression becomes more recurrent or chronic it becomes harder to treat, but adjustments to treatment parameters can make therapeutic gains and relapse prevention much more likely – e.g. adjusted treatment focus, adapted goals, increased therapeutic dose, adjusted session frequency, careful task calibration, continuation/maintenance sessions
4.  Highly complex presentations. A range of biological, psychological and social factors can interact to produce complicated clinical presentations that appear to need idiosyncratic or non-standard treatment.  In fact, many such cases will respond to standard CBT when barriers to treatment are tackled, the patient is well-prepared and the intervention is delivered in a timely fashion.  In a small proportion of complex cases the maintenance of depression is subtly or substantially altered, for example when high levels of co-morbidity are present.  Under those conditions individual case formulations can be used to adapt treatment appropriately, often by targeting trans-diagnostic processes.

Training modalities
Attendees are encouraged to reflect on and discuss difficult cases of depression they have treated.  The workshop will use a blend of didactic, observation, experiential and practical teaching methods, including role-play demonstrations.

Key references
1. James, I.A., Reichelt, F.K., Freeston, M.H. & Barton, S.B. (2007).  Schemas as Memories: Implications for Treatment.  International Journal of Cognitive Psychotherapy, 21, 51-57
2. Barton, S.B., Armstrong, P., Freeston, M.H. & Twaddle, V. (2008).  Early Intervention for Adults at High Risk of Recurrent/Chronic depression:  Cognitive Model and Clinical Case Series. Behavioural and Cognitive Psychotherapy, 36, 263-282
3. Barton, S.B., Armstrong, P & Freeman, E. (in press, 2017).  Treating Complex Depression with Cognitive Behavioural Therapy. The Cognitive Behavioural Therapist (special issue on Complex Cases, 2017)
4. Barton, S.B. & Armstrong, P (in prep, 2018).  CBT for Major Depression: An Integrated Approach (Sage)

Implication for everyday clinical practice of CBT
Therapists will be encouraged to face rather than avoid the challenges presented by difficult cases. This will be supported by a clear theoretical framework and practical clinical guidance.

Brief description of workshop leader
Stephen Barton is an accredited CBT practitioner, supervisor and trainer who has specialised in the treatment of depression for over 15 years.  He formerly led the Newcastle CBT Diploma (2011-16) and is Head of Training at the Newcastle CBT Centre.  He has specific interests in treating complex depression, supervision, therapeutic responsiveness and personal development within psychotherapy training.



 

A new translational treatment for persecutory delusions: The Feeling Safe Programme

Daniel Freeman, Felicity Waite and Bryony Sheaves, University of Oxford

Workshop - More information...

Scientific background and description of workshop:
Persecutory delusions are one of the most frequent and distressing psychotic experiences. In the last ten years they have become the focus of considerable psychological research. This research is being used by Professor Freeman and colleagues to develop a new targeted, personalised, modular therapy for patients with persecutory delusions, called the Feeling Safe Programme. The aim is for a much higher recovery rate in delusions. The workshop will provide an overview of the key elements within the new approach, including the assessment process, reducing sleep disturbance, tackling worry, enhancing self-confidence, and building a renewed sense of safety.

Key learning objectives:
1. Be aware of a clear framework for understanding and treating severe paranoia.
2. Know a range of techniques for improving sleep, reducing worry, enhancing self-confidence, and testing out fears in patients with persecutory delusions.
3. Appreciate the spirit and style of the Feeling Safe Programme.

Training modalities
Slides, live demonstrations, video case examples, role plays, small group discussions.

Key references
1. Freeman, D. (2016). Persecutory delusions: a cognitive perspective on understanding and treatment. The Lancet Psychiatry, 3, 685-692.
2. Freeman, D., Bradley, J., Waite, F., Sheaves, B., DeWeever, N., Bourke, E., McInerney, J., Evans, N., Černis, E., Lister, R., Garety, P. & Dunn, G. (2016). Targeting recovery in persistent persecutory delusions: a proof of principle study of a new translational psychological treatment. Behavioural and Cognitive Psychotherapy, 44, 539-552.
3. Freeman, D. & Waite, F. (2017). Persistent persecutory delusions: the spirit, style and content of targeted treatment. World Psychiatry.

Implication for everyday clinical practice of CBT
Workshop attenders should feel more confident in how to approach the treatment of severe paranoia and learn a range of techniques adapted specifically for this client group.

Brief description of workshop leaders
Daniel Freeman is an NIHR Research Professor at the University of Oxford, a consultant clinical psychologist in Oxford Health NHS Foundation Trust, and a Fellow of University College, Oxford. He leads the Oxford Cognitive Approaches to Psychosis (O-CAP) research group, which focuses on developing the understanding and treatment of psychotic experiences. Dr Bryony Sheaves and Dr Felicity Waite are clinical psychologists in the research group, who have been therapists in a number of the trials developing the Feeling Safe Programme.



 

One-session treatment of specific phobias (including live treatment session)

Lars Goran Ost, Stockholm University

Workshop - More information...

Scientific background and description of workshop:
Specific phobia is the most prevalent of all psychiatric disorders in the general population with a lifetime prevalence of 12.5%. 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. I have 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 behavior analysis of the catastrophic beliefs the patient has in relation to a possible confrontation with the phobic object or situation. Exposure in-vivo is done as a series of behavioral experiments to help the patient test the catastrophic beliefs they have. In animal phobics participant modelling is used as an adjunct.        
During the last two decades I have done 12 randomized clinical studies on phobias of spiders, snakes, blood-injury, injections, dental care, flying and enclosed places in adults and 2 studies 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 between 78-93%. The effects are maintained, or furthered, at the 1-year follow-up. These results have been replicated in at least about RCTs carried out in Holland, Belgium, England, Germany, Austria, Norway, Spain, USA, Canada, and Australia.

Key learning objectives:
1. What is one-session treatment?
2. How can catastrophic beliefs be assessed?
3. How can one-session treatment be applied for various specific phobias?
4. What does the research (including a meta-analysis) say about its efficacy?

Training modalities
1. Lectures
2. Video demonstrations
3. Live treatment (if possible)

Key references
1. Öst, L-G. (1989). One-session treatment for specific phobias. Behaviour Research and Therapy, 27, 1-7.
2. Ollendick, T.H., Öst, L-G., Reuterskiöld, L., Costa, N., Cederlund, R., Sirbu, C., Davis III, T.E. & Jarrett, M.A. (2009). One-session treatment of specific phobias in youth: A randomized clinical trial in the USA and Sweden. Journal of Consulting and Clinical Psychology, 77, 504-516.
3. Davis III, T., Ollendick, T. & Öst, L-G. (Eds.) (2012). Intensive one-session treatment of specific phobias. New York: Springer.

Implication for everyday clinical practice of CBT
Participants will get a thorough introduction to a treatment that can easily be applied in everyday clinical practice.

Brief description of workshop leader
Professor Öst founded the Swedish Association for Behavior Therapy in 1971, and was one of the co-founders of the European Association for Behavior Therapy the same year. He has done research on all anxiety disorders as well as schizophrenia, drug addiction, and obesity. Öst developed the one-session treatment for specific phobias and has inspired clinicians in many countries around the world to use it in their clinical practice. Likewise, researchers in seven European countries, as well as in USA, Canada and Australia have done randomized controlled studies of this treatment. He has published 260 peer-reviewed articles, books, and book chapter.


 

“Voices within four walls” – Culturally competent CBT for South Asians

Nusrat Hussain, University of Manchester,
Nadeem Gire, Central Lancashire and
Farah Lunat, Lancashire Care NHS Foundation Trust

Workshop - More information...

We found that in order to effectively work with clients from this particular community, therapists need to consider and develop three fundamental areas of cultural competence; (1) Awareness of relevant cultural issues and preparation for therapy; (2) Assessment and engagement and, (3) Adjustments in therapy techniques. This workshop will focus on sharing knowledge of methodology and process of adaptation and outcome of our work with British South Asians and work in Pakistan.

Prof Husain and colleagues will present their research findings related to maternal depression, other common mental disorders, self-harm and psychosis.   They will discuss the process of cultural adaptation and how we can use the lessons learnt from this work to influence practice in the UK. This is important because the UK population is becoming increasingly diverse with second and third generation British South Asians (BSA) who do not have language difficulties but still have significant differences in culture compared to the wider population. The practice of cultural consultation will also be illustrated with some case studies.

Key learning objectives:
1. Recognise disparities in mental health and access to adequate healthcare for South Asians in the UK and mental health treatment gap in Low and Middle Income Counties
2. Identify different approaches and appropriate resources needed to deliver culturally competent therapies to this group
3. Recognise and understand the complexities and influences of religion and culture independent to each other when providing healthcare
4. Recognize and implement adaptations in three areas i.e., assessment, awareness and adjustment of therapy techniques

Key references
1.  Patel V, Prince M. Global mental health: a new global health field comes of age. JAMA. 2010 May 19;303(19):1976-7.
2.  Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, Rahman A. No health without mental health. The lancet. 2007 Sep 14;370(9590):859-77.
3.  Masood, Y., Lovell, K., Lunat, F., Atif, N., Waheed, W., Rahman, A., ... & Husain, N. (2015). Group psychological intervention for postnatal depression: a nested qualitative study with British South Asian women. BMC women's health, 15(1), 109.
4.  Naeem, F., Saeed, S., Irfan, M., Kiran, T., Mehmood, N., Gul, M., ... & Farooq, S. (2015). Brief culturally adapted CBT for psychosis (CaCBTp): a randomized controlled trial from a low income country. Schizophrenia research, 164(1), 143-148.

Brief description of workshop leaders
Professor Nusrat Husain is Professor of Psychiatry at the University of Manchester and consultant psychiatrist at Lancashire Care NHS Foundation Trust.  His research area is Global Mental Health and Cultural Psychiatry and his international work not only has an impact in those countries but his understanding of working across cultures is proving very useful for the delivery of culturally sensitive care to the diverse population in the UK. Professor Husain is currently leading two large RCT’s one is brief psychological intervention for the prevention of self-harm and suicide (n= 624) funded by the MRC/DFID/Wellcome Trust and group CBT for postnatal depression in British South Asian women (n= 720) funded by NIHR. 

Farah Lunat is a Deputy Trial Manager of an NIHR funded trial for postnatal depression in British South Asian women (ROSHNI-2).  She is a global mental health researcher with a focus on cultural adaptation of psychological therapies for ethnic minorities with a special interest in maternal mental health and wellbeing.

Nadeem Gire is an NIHR PhD student and a mental health researcher with experience of cross cultural research.  His special interests include cultural adaptation, psychosis and digital inclusion.


 

The ABC of CBT: reviewing basic CBT skills and applications

Helen Kennerley, Oxford Cognitive Therapy Centre

Workshop - More information...

Scientific background and description of workshop:
This workshop will encourage participants to re-visit and perhaps refresh some of the “basic skills”, appreciating their mechanism their and value in helping people with both “straightforward” and “complex” difficulties. There is the risk that we assume that the CBT fundamental techniques will not be sufficient to help all our patients and yet there is good reason to persevere with classic Beckian CBT.  Clinical illustrations will show the value of “the basics” with a range of patients, including those whose problems are chronic, challenging or who also have a personality disorder.  

Key learning objectives:
1. Revision of CBT basic skills
2. Recognition of diversity of these skills with both “straightforward” and “complex” difficulties.

Training modalities
•   PowerPoint / verbal presentation
•   Video illustration
•   Brief role play
•   Short discussions

Key references
1. Beck, A.T. et al (1997)  Cognitive Therapy of Depression, Guilford Press
2. Beck, J.S. (2011) Cognitive Behaviour Therapy: basics and beyond,  Guilford Press
3. Kennerley, H., Kirk, J. & Westbrook, D. (2017) An Introduction to Cognitive Behaviour Therapy: skills and applications, Sage

Implication for everyday clinical practice of CBT
Maximising the use of CBT “fundamentals” .  This means getting the most out of the techniques that are familiar to all CBT therapists.  Using what we know to best advantage before trying other, less well tested techniques.

Brief description of workshop leader
Consultant Clinical Psychologist and a founder member of the Oxford Cognitive Therapy Centre, where she was the director of the University of Oxford / OCTC postgraduate short-courses in Advanced Cognitive Therapy Studies and MSc for many years. She is an experienced CBT clinician specialising in childhood trauma, dissociative disorders, and self-injurious behaviours. She has also taken a lead role within OCTC for developing Supervision training and the use of Socratic Methods.  She has made valuable contributions to the field of cognitive therapy through her popular workshops and her writings. Amongst other publications, she is the author of Overcoming Childhood Trauma, co-author of An Introduction to Cognitive Behaviour Therapy, co-editor of Cognitive Behavioural Approaches to Dissociation.  Her self-help book, Overcoming Anxiety has been highly commended by the British Medical Association.


 

CBT for Clinical Perfectionism: The good, the bad and the reality

Roz Shafran, University College London, Great Ormond Street Institute of Child Health

Workshop - More information...

Scientific background and description of workshop:
“Clinical perfectionism” is a highly specific construct designed to capture the type of perfectionism that poses a clinical problem. The core psychopathology of clinical perfectionism is an overevaluation of achievement and striving that causes significant adverse consequences. Clinical perfectionism has been implicated in the maintenance of psychopathology, in particular eating disorders.  A specific cognitive-behavioural intervention has been developed by the Oxford Eating Disorders Research Group for the treatment of clinical perfectionism in a range of mental health disorders including eating disorders, anxiety disorders and depression. More recently, the intervention has been enhanced by incorporating techniques used by clinical research groups in Australia. The intervention can be delivered in traditional face-to-face therapy, or in the form of guided self-help. A recent systematic review and meta-analysis indicates that the intervention is effective in reducing perfectionism as well as associated psychopathology. The workshop will be responsive to the participants’ needs but aims to describe the theoretical rationale for the intervention, assessment and formulation techniques, and key treatment interventions.

Key Learning objectives:
•   To understand a cognitive-behavioural analysis of clinical perfectionism and the factors that contribute to its maintenance
•   To learn how to assess clinical perfectionism and determine when it may warrant a specific intervention
•   To be familiar with the cognitive-behavioural strategies used to address clinical perfectionism
•   To be aware of the relevant research literature and current evidence-base for the intervention

Training modalities
The workshop will be interactive and include both experiential and didactic teaching and videos. Participants will have a chance to discuss their own cases.

Key references
1.  Lloyd, S., Schmidt, U., Khondoker, M., & Tchanturia, K. (2015). Can psychological interventions reduce perfectionism? A systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 43, 705-731
2.  Shafran, R., Egan, S., & Wade, T. (2010). Overcoming Perfectionism: A self-help guide using Cognitive Behavioural Techniques.  Constable & Robinson.
3.  Shafran, R., Cooper, Z., & Fairburn, C. G. (2002). Clinical perfectionism: a cognitive- behavioural analysis. Behaviour Research and Therapy, 40, 773-791.

Implications for Everyday Practice of CBT
The implications of this workshop is that practitioners are improved identification, assessment and treatment of a common clinical problem occurring in the context of a range of Psychopathology

Brief Description of Workshop Leader
Roz Shafran is Chair in Translational Psychology at the UCL Great Ormond Street Institute of Child Health. She is founder of the Charlie Waller Institute of Evidence Based Psychological Treatment and a former Wellcome Trust Career Development Fellow at the University of Oxford. Her clinical research interests focus on the development, evaluation, dissemination and implementation of cognitive behavioural treatments for eating disorders, obsessive compulsive disorder and perfectionism across the age range. She is currently working to understand and integrate evidence-based psychological treatments in young people with mental health disorders in the context of physical illness. She has provided national and international training workshops in her areas of clinical expertise, has over 120 publications, and has received an award for Distinguished Contributions to Professional Psychology from the British Psychological Society, the Marsh Award for Mental Health work and the Positive Practice award for ‘Making a Difference’.


 

Sharpening skills for seriously slick supervisors

Blake Stobie, South London and Maudsley NHS Foundation Trust

Workshop - More information...

Scientific background and description of workshop:
The effectiveness of CBT is diluted by therapists drifting away from treatment protocols. Some studies (Stobie et al., 2007; Waller et al. 2012) have highlighted disquieting descriptions of substandard therapy provision under the guise of CBT, and others (Tobin et al., 2007) have revealed therapists ignoring treatment manuals and mixing behavioural and dynamically informed interventions in their treatment of clients.
Supervision is recommended as an antidote to drift, but supervisory processes are themselves susceptible to drift, in part because supervision protocols are not as developed as therapy protocols for specific disorders.
This workshop will present some practical ways of preventing, identifying and addressing drift within our supervisory practice, to improve our supervision and the outcomes of our supervisees.

Key learning objectives:
1. To clarify the purpose of supervision
2. To identify the causes and effects of drift within supervision
3. To discuss practical techniques for addressing these by means of case examples
4. To consider the practical implications for your own supervisory practice
5. To establish techniques for preventing and tackling drift in your supervision.

Training modalities
Illustrative case examples
Role plays
Discussion

Key references
1. Deacon, B.J., Farrell, N.R., Kemp, J.J., Dixon, L.J., Sy, J.T., Zhang, A.R., & McGrath, P.B. (2013). Assessing therapist reservations about exposure therapy for anxiety disorders: The Therapist Beliefs about Exposure Scale. Journal of Anxiety Disorders, 27, 772-780.
2. McManus, F., Rakovshik, S., Kennerley, H., Fennell, M., & Westbrook, D. (2012). An investigation of the accuracy of therapists’ self-assessment of cognitive behaviour therapy skills. British Journal of Clinical Psychology, 51, 292-306.
3. Waller, G. & Turner, H. (2016). Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behaviour Research and Therapy, 77, 129-137.

Implication for everyday clinical practice of CBT
This applied workshop will present clear practical strategies for improving clinical supervision in CBT.  The content will have everyday relevance for supervisors seeking to improve their practice, and clinicians wanting to extract more from their own supervision.

Brief description of workshop leader
Blake is the Acting Head of the Centre for Anxiety Disorders and Trauma (CADAT) at the Maudsley. He also manages a service which provides CBT to patients with severe anxiety disorders which have not responded to previous pharmacological and psychological treatments, and from this has developed an interest in how treatments fail and what can be done to prevent this. He supervises and teaches on several psychology and CBT training courses. Blake’s interest in this area has also developed from his own personal experiences of receiving supervision from and working with talented and creative colleagues, who collaborate in developing and refining their supervision delivery.


 

Rumination-focused Cognitive Behavioural Therapy

Ed Watkins, University of Exeter

Workshop - More information...

Background
Rumination has been identified as a core process in the maintenance and onset of depression (Nolen-Hoeksema, 1991; 2000) and as a possible transdiagnostic mechanism contributing to co-morbidity (Harvey et al., 2004; Nolen-Hoeksema & Watkins, 2011). Furthermore, rumination seems to be a difficult-to-treat symptom, which is associated with poorer outcomes for psychological therapy. This workshop will illustrate how the CBT approach can be modified to reduce rumination in chronic, recurrent and residual depression and co-morbid anxiety, using new approaches derived from clinical experience and experimental research. A programme of research by Dr Watkins has suggested that the thinking style adopted during rumination can determine whether it has helpful or unhelpful consequences on social problem solving (Watkins & Moulds, 2005) and emotional processing (Watkins, 2004, 2008). This experimental work has inspired a novel approach to treating depression, called Rumination-focused CBT, which focuses on changing the process of thinking, rather than simply changing the content of thinking, in order to be more effective in succesfully reducing rumination and treating depression (Watkins, 2016). There is now empirical backing for the efficacy of this approach for difficult-to-treat patients in terms of a positive open case series (Watkins et al., 2007) and a randomised controlled trial funded by NARSAD (Watkins et al., 2011; Watkins, 2015). Moreover, a recent trial of group RFCBT has found that it outperformed standard group CBT for outpatient depression (Hvennegard, in preparation). In addition, group and internet versions of RFCBT have been shown to be effective at halving the rates of depression and anxiety in a vulnerable high-risk group over 1 year (Topper et al., 2017). The workshop will review the theoretical background and core techniques of the therapy, including functional analysis of thinking style, behavioural activation, use of imagery, concreteness, experiential exercises and behavioural experiments to coach patients to shift to more adaptive styles of thinking. This workshop has been successfully received at a number of BABCP and EABCT events.

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

The workshop is designed for therapists with an intermediate knowledge of CBT.
Training modalities will include a mixture of didactic teaching, experiential exercises and watching of video.

Key References
Watkins, E.R. (2016). Rumination focused cognitive behavioral therapy for depression. Guilford Press

Watkins, E.R. (2015). Psychological Treatment of Depressive Rumination. Current Opinion in Psychology, 4:32-36.

Watkins, E.R., Mullan, E.G., Wingrove, J., Rimes, K., Steiner, H., Bathurst, N., Eastman, E., & Scott, J. (2011). Rumination-focused cognitive behaviour therapy for residual depression: phase II randomized controlled trial. British Journal of Psychiatry, 199, 317- 322. Doi:10.1192/bjp.bp.110.090282.

Implication for everyday clinical practice of CBT
Rumination is a common problem in patients with anxiety and depression and can be a block to effective therapy. This workshop provides strategies for tackling rumination within everyday CBT practice.

Brief description of workshop leader
Dr Watkins is a pre-eminent expert in the field of experimental psychopathology and psychological treatments for depression, with a particular emphasis on understanding and treating rumination and worry. He is the co-founder of the Mood Disorders Centre, University of Exeter, a partnership between the University of Exeter and Devon Partnership NHS Trust, specialising in psychological research and treatment for depression. He has specialist clinical training and expertise in cognitive therapy for depression.


 

Group-based interventions for couples: A cost-effective way of enhancing  relationships and treating relationship distress

Marion Cuddy,  South London & Maudsley NHS Foundation and
Dan Kolubinski, Efficacy and Reconnect UK 

Workshop - More information...

Background
Group interventions for couples are widely used in other countries both for
preventative/relationship enhancement purposes and to address relationship distress.
These programmes (e.g. The Couple CARE programme; Halford et al., 2004) are based on
behavioural couple therapy and focus on psycho-education about relationships,
communication skills and problem solving training, and on developing strategies for
enhancing commitment and relationship satisfaction.

Numerous studies support the long-term effectiveness of these programmes in preventing
relationship problems and divorce (e.g. Hahlweg et al., 1998). Furthermore, there is good
evidence that they can be of benefit to couples already in distressed relationships
(Hahlweg & Richter, 2008).

This workshop will start with a brief overview of behavioural couple therapy (BCT). The
main focus of the workshop will be on how BCT principles can be used to work with
couples in groups, either to enhance their relationship, to prevent future difficulties, or to
address relationship distress.

Objectives
By the end of this workshop, participants should:

1. Be familiar the BCT model and key interventions
2. Understand how the BCT model can be applied to working with couples in a group
setting, either for the purpose of relationship enhancement or as an intervention for
relationship distress.
3. Have practiced key interventions such as communication skills training
4. Know about a range of exercises and interventions that can be used with couples in a
group setting.

This workshop is suitable for participants new to behavioural couple therapy, although
some experience of working with couples would be an advantage.

Training Modalities
The workshop will be a mixture of didactic presentation, large group discussion, and small
group skills-practice exercises. The first part of the day will focus on presenting the
model and key interventions, along with some skills practice. The second part of the day
will be more experiential, with participants working in pairs and role playing clients
attending a workshop for couples, in order to gain a more in depth understanding of some
of the techniques and exercises involved.

Key references
1. Hahlweg K., Markman H.J., Thurmaier, F., Engl, J. & Eckert, V. (1998). Prevention of marital
distress: Results of a German prospective longitudinal study. Journal of Family
Psychology, 12, 543-556.
2. Hahlweg, K. & Richter, D. (2008). Prevention of marital instability and distress. Results of
an 11-year longitudinal follow-up study. Behaviour Research and Therapy, 48(5), 377-
383.
3. Halford, W.K., Moore, E., Wilson, K.L., Farrugia, C., & Dyer, C. (2004). Benefits of flexible
delivery relationship education: An evaluation of the couple CARE program. Family
Relations, 53(5), 469-476.

Implications
Behavioural couple therapy is a rapidly growing field in the UK. However, to date
provision across the NHS and in the private sector is limited and expensive. Offering
group interventions based on BCT may improve access, as well as offering a cost-
effective way of preventing and treating relationship distress.

Workshop Leaders
Marion Cuddy is a clinical psychologist based at the Maudsley Hospital in London. She
specialises in cognitive behavioural interventions for individuals and couples, and is
particularly interested in working with couples where one partner has mental or physical
health difficulties. Her role includes facilitating workshops for couples in distressed
relationships.

Dan Kolubinski earned his MA in Counselling Psychology with a joint specialisation in CBT
and family therapy.  He now works in private practice in London and also runs retreats
for couples.  Dan has worked with couples in varying degrees of distress for 10 years
and runs relationship education workshops.


 

State of the art delivery: Maximising outcomes in low intensity working

Christopher Williams, University of Glasgow and
Joanne Woodford, University of Exeter

Workshop - More information...

Cognitive behavioural therapy is an evidence-based and much recommended form of therapy, and is increasingly delivered in different modalities including High and Low intensity working. 
Part of the challenge of Low intensity (LI) working is that time is limited both in terms of session length and total number of sessions. It is important therefore to make sure that the available time is utilised effectively.
Together Chris Williams and Jo Woodford have over 25 years of experience in the development, adaptation, delivery and evaluation of low intensity CBT interventions.  Informed by research and practice, innovative approaches to overcoming barriers to access and ongoing engagement in low-intensity CBT interventions, especially when working with harder-to-reach populations, will be presented during this workshop.  Further, the workshop will help address the integration of behaviour change techniques into low intensity approaches, in line with recent changes to the National Curriculum for the Education of Psychological Wellbeing Practitioners (UCL).

The workshop will identify and help practitioners overcome 12 essential blockages that reduce effectiveness throughout the low intensity pathway:
a). In referral – working to overcome unintended referrer  biases
b). In assessment – making sure the right people receive a LI intervention
c). Overcoming assessor bias
d). Completing a learning assessment
e) Refining the “sell” of low intensity interventions
f). Choosing evidence-based approaches
g). Delivering a first session that maximise the chances of attending a second session
h). Choosing the right sort of support- face to face, phone, email, or classes
i). Who is best suited to provide support and where should support be delivered, especially for harder to engage populations
j). Moving away from “homework”
k). Preparing for discharge so relapse is reduced
l). Reviewing the wider system- what messages do we teach people about self-care?

Learning outcomes:
• Attendees will increase their knowledge of key areas essential to assessing and identifying people who will do well with low-intensity interventions.
• Develop skills in engaging users in ways of working that are both relevant and acceptable.
• Enhance knowledge and skills in engaging, delivering,  and ending low intensity interventions.
• Develop skills in engaging harder-to-reach populations.
• Understand the necessary steps to complete audits at an individual practitioner and service level to identify areas to incrementally improve outcomes in all 12 areas.

Content will include:
Slide-based presentation
Group and round table discussion
Case discussion and problem-focused practice
Self-reflection and self-practice tasks

The workshop is based on a series of systematic reviews and randomised controlled trials of low-intensity CBT interventions for harder to reach populations completed by the workshop leaders and colleagues, coupled with extensive experience helping establish local and national treatment pathways in Scotland (NHS 24), England (NHS Direct), and Canada (Canadian Mental Health Association). The workshop aims to encourage dissemination of learning points to date and help individual practitioners and services reflect on ways of maximising outcomes.

Dr Chris Williams is Professor at the University of Glasgow and his work focuses on widening access to care. This includes www.livinglifetothefull.com which receives over 26 million hits/year. His work has led to  country-wide roll-outs of in four countries.
Dr Joanne Woodford is a Research Fellow at the University of Exeter. Joanne has a special interest in developing and improving access to evidence based psychological interventions for people with depression, especially those with chronic health conditions. She has developed and trialled a range of written self-help materials for people with depression, informal carers and facing chronic health difficulties and dementia.

Key references
1. Farrand, P., & Woodford, J. (2013).  Impact of support on the effectiveness of written cognitive behavioral self-help: A systematic review and meta-analysis of randomized controlled trials.  Clinical Psychology Review, 33,182-195.
2. Farrand, P., Woodford, J., Anderson, M., Ventatasubramanian, S., Llewellyn, D., Ukoumnne, O., Adlam, A., & Dickens, C. (In Press). Behavioural activation written self-help to improve mood, well-being and quality of life in people with dementia supported by informal carers (PROMOTE): study protocol for a single-arm feasibility trial.  Pilot and Feasibility Studies
3. Bennett-Levy, J., Richards, D.A., Farrand, P., Christensen, H., Griffiths, K., Kavanagh, D., Klein, B., Lau, M., Proudfoot, J., White, J. & Williams, C. (eds) (2010).The Oxford Guide to Low Intensity CBT Interventions. Oxford: Oxford University Press.


 

Beyond fear: Understanding and treating military trauma

Martina Mueller, Oxford Cognitive Therapy Centre

Workshop - More information...

The psychological injuries following deployment in conflict zones are diverse, often cumulative and extend beyond high threat to self.  They include exposure to horrific losses, extreme human suffering and moral injury caused by witnessing or the perception of perpetration of immoral acts. These experiences occur in a context of military training and culture which will shape post traumatic responses and coping styles. Reintegration post–deployment, whether as a soldier or re-entering civilian life, brings with it the need to renew a sense of safety, trust and connection to the civilian world.  Therapists need to adapt evidence-based interventions to respond to these complex clinical demands efficiently and effectively

Learning outcomes
This interactive workshop will build therapists’ confidence in safely addressing the specific needs of traumatized veterans and serving personnel and provide participants with:
• An understanding of the nature and potential impact of military trauma exposure
• Knowledge of how to apply sound principles of assessment and formulation to enable realistic treatment planning
• A conceptual understanding of the available options for working with cumulative trauma
• Understand key tasks in preparing for working safely with trauma memories
• How to work with common cognitive themes including those arising from killing versus murder, participation v observation and mental contamination.
• Consider strategies for facilitating adaptive living with loss

Teaching modalities
The workshop will use a variety of teaching methods to facilitate learning. Clinical material will be used throughout to illustrate teaching points.
Tailoring ‘talking therapies’ programmes to the needs of veterans
The key outcomes are:
• Improved awareness and recognition
• Improved clinical services

Martina Mueller is a Consultant Clinical Psychologist and works for the Oxford Cognitive Therapy Centre (OCTC) leads the trauma service for Oxford Health NHS Foundation Trust. She is the Course Director of the Post Graduate Certificate in CBT for Psychological Trauma at the University of Oxford. She is widely respected for her innovative clinical work and specializes in complex reactions following adult trauma with a special interest in the treatment of multiple and prolonged trauma.  Martina has co-edited the Oxford Guide to Behavioural Experiments in Cognitive Therapy, and the Oxford Guide to Surviving as a CBT Therapist, OUP.

Key references
1. Gray, M. J., Schorr, Y., Nash, W., Lebowitz, L., Amidon, A., Lansing, A., Maglione, M., et al. (2012). Adaptive disclosure: an open trial of a novel exposure-based intervention for service members with combat-related psychological stress injuries. Behavior Therapy, 43(2), 407-15.
2. Hundt, N. E., Barrera, T. L., Arney, J., & Stanley, M. a. (2016). “It’s Worth It in the End”: Veterans’ Experiences in Prolonged Exposure and Cognitive Processing Therapy. Cognitive and Behavioral Practice.
3. Mueller, M & Andrews, P (2016) Making Sense of Military Trauma. Available from www.octc.co.uk


     
 

Queering CBT: Working with people who do not identify as straight or cisgender

Matt Bristow, Anna Hutchinson and Hannah Waters, Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust

Workshop - More information...

Who the workshop is aimed at:
Practitioners who are interested in thinking about the needs of clients who do not identify as straight or cisgender (e.g. LGBT) and the how to think about experiences of homophobia and transphobia in therapy.

Background:
Do you know your demiboys from your tomgirls? Or how pansexual differs from bisexual? The ways in which we think about and discuss gender identify and sexuality continue to evolve and diversify at a rapid pace. This can lead to practitioners feeling that the language and concepts they have available to discuss experiences related to gender and sexuality are no longer sufficient when working with minority populations. At the same time, the numbers of people seeking support from professionals, particularly around gender identity, is on the rise.
As well as briefly considering the separate role of specialist services, this workshop aims to help practitioners feel confident in working with sexuality and gender as part of their usual practice in relation to a range of presenting difficulties. The workshop guides participants through the myriad of different ways in which people may identify in terms of gender and sexual orientation. It also explores how experiences of homophobia and transphobia may be expressed in common mental health difficulties and considers a framework for considering social context within individual formulation / case conceptualisation.

Learning Objectives:
Participants will be able to:
•  use current ideas and terminology around gender identity and sexual orientation, and draw upon greater understanding of the issues that may affect clients in these domains;
•  describe the distinct role of professionals in supporting transgender, non-binary and gender non-conforming clients;
•  consider how gender identity and/or sexuality development may intersect with presenting difficulties seen in other health settings;
•  include an understanding of the potential impact of experiences related to sexuality or gender identity in assessment, formulation and intervention across a range of presentations.

Teaching Methods:
The workshop will combine a mixture of presentation, group discussion, video clips, and activities (e.g. group discussion of case vignettes).

Workshop Leaders:
Matt Bristow, Anna Hutchinson and Hannah Waters are clinical psychologists at the Gender Identity Development Service: a national, specialist service for children and adolescents who are experiencing difficulties in the development of their gender identity. They are interested in how the impact of clients’ experiences of discrimination and oppression can be considered within cognitive-behavioural therapy. Between them, Matt, Anna and Hannah have previously worked in a number of different settings and with different age groups, including HIV and physical health services, as well as in IAPT teams.

Background Reading:
1. Austin, A. and Craig, S.L. (2015) Transgender affirmative cognitive behavioural therapy: clinical considerations and applications. Professional Psychology: Research and Practice, 46(1), 21-29. doi: 10.1037/a0038642
2. Meyer, I H. (2003). Prejudice, social Stress, and mental health in lesbian, gay and bisexual populations: conceptual issues and research evidence.  Psychological Bulletin, 129, 674-697. doi: 10.1037/0033-2909.129.5.674
3. Puckett, J.A. & Levitt, H.M. (2015). Internalized stigma within sexual and gender minorities: change strategies and clinical implications. Journal of LGBT Issues in Counseling, 9(4), 329-349. doi: 10.1080/15538605.2015.1112336
4. Wren, B. (2014) ‘Thinking post-modern and practising in the Enlightenment’: managing uncertainty in the treatment of transgendered adolescents. Feminism and Psychology, 24(2),271-291. doi: 10.1177/0959353514526223