PRE-CONFERENCE WORKSHOPS

Tuesday 17th July 2018.
9.30 am - 5.00pm

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


 

Behavioral and Cognitive Therapy for Adult Obsessive Compulsive Disorder
Gail Steketee, Boston University, USA

Workshop 1- More information..

Obsessive compulsive disorder (OCD) has been shown to have multiple types of symptoms that include (1) contamination fears and washing or cleaning rituals; (2) obsessions about harming, catastrophes and mistakes that provoke compulsive checking; (3) magical thinking and mental neutralizing rituals; and symmetry; and (4) exactness concerns associated with ordering rituals.  This workshop will clarify the nature of the obsessions and associated beliefs and emotions, as well as the behavioral consequences that include avoidance, mental rituals and overt compulsions.  Research on beliefs or interpretations associated with OCD symptoms include over-importance of thoughts, overestimation of harm, excessive responsibility, and the need for certainty and perfectionism. Participants will observe and practice how to apply functional models of OCD symptoms and beliefs with current cases. Evidence-based treatments for OCD include behavioral exposures and blocking of rituals and cognitive therapy directed at obsessions. Participants will practice applying exposure and response prevention (ERP) and cognitive therapy (CT) techniques that target patients’ faulty thinking and beliefs in an integrative fashion.  Subtypes of OCD that present special challenges such as harming obsessions and magical thinking will be considered, along with comorbid problems that may influence treatment strategies. Case materials illustrating patients’ symptoms and treatment will be included, and participants will be invited to discuss their cases in order to gain practical experience applying CBT strategies.

This workshop will enable beginning and intermediate mental health clinicians to diagnose, assess and develop a CBT model with their clients/patients.  They will be able to select and guide clients to apply exposure and response prevention strategies in a stepwise fashion, incorporating cognitive intervention aimed at altering problematic beliefs that impede progress during ERP.  They will gain initial experience in applying these techniques and will be encouraged to practice these methods with current clients

Dr. Gail Steketee is Professor and former Dean of the Boston University School of Social Work. She is currently the Past-President of the 5,000-member Association of Behavioral and Cognitive Therapies (ABCT).  With degrees from Harvard University (A.B.) and Bryn Mawr School of Social Work (MSW, PhD), she has focused her clinical research on developing and testing treatments for OC spectrum conditions, including obsessive compulsive disorder, body dysmorphic disorder, and more recently, hoarding disorder.  She has published over 230 articles and chapters, and more than a dozen books on these topics. Her books include 2 edited volumes on OCD (Handbook of obsessive compulsive and spectrum disorders, 2012; Cognitive approaches to obsessive compulsive disorder: Theory, assessment and treatment, Frost & Steketee 2002) and 3 books on treating OCD (Overcoming compulsive disorder: Behavioral and cognitive therapy, 1999; Treating OCD with cognitive therapy, Wilhelm & Steketee, 2006; Treatment of obsessive compulsive disorder, 1993).  Media outlets including the New York Times, the Chicago Tribune, and the Washington Post have featured her work.  Dr. Steketee was elected to the American Academy of Social Work and Social Welfare in 2012, and is the recipient of several career awards, including from the International OCD Foundation in 2013.  She serves on editorial and professional boards in social work and psychology and lectures frequently on OC spectrum conditions.

References
Steketee, G. (1999). Overcoming compulsive disorder: Behavioral and cognitive therapy. Therapist manual and Patient manual. Oakland, CA: New Harbinger Press.
Wilhelm, S., & Steketee, G. (2006). Cognitive therapy for obsessive compulsive disorder: A guide for professionals, New York: Guilford. Chapter 3: Summary of Cognitive Therapy Techniques (pp. 35-46).
Abramowitz, J.S. & Jacoby, R.J.(2015). Obsessive-Compulsive Disorder in Adults, Hogrefe.


 

The Assessment, Diagnosis, and Treatment of Anger Disorders
Ray di Guiseppe, St John's University, New York, USA

Workshop 2 - More information...

This workshop will propose a model to understand anger as a clinical problem that can guide research, assessment, diagnosis, and treatments. A review of the research on anger will provide the basis for understanding how anger can be dysfunctional and how it differs from fear, anxiety, sadness and depression disorders. Research on the comorbidity of anger in psychiatric samples reveals that anger is not a depression, mania, impulse, or personality disorders, as suggested by many theoretical models but remains a separate clinical entity.

The workshop will review how anger symptoms are comorbid with other disorders and how this comorbidity negatively influences the treatment of the primary disorder. It also will specify how anger can be conceptualized as an independent syndrome.  Attention will focus on changes in the DSM-5 category of Intermittent Explosive Disorder and Oppositional Defiant Disorder as examples of anger disorders.

How anger is represented in psychological tests and some problems that exist because of the present conceptualization of anger and common problems in anger assessment instruments and structured interviews will be reviewed. A model for assessing anger that can be used to individualize treatment will be presented.  The research on anger treatments will also be reviewed and show which interventions has been proven as most effect. Anger treatments usually employ one manuals for all participants. Most researcher fail to identify different types of anger problems that may require different interventions. Such models do not help clinicians assess important aspects of the anger experience and use their assessment to construct an individualized case conceptualization.

The workshop will propose a model of the characteristics of anger that informs assessment that will help clinicians build case conceptualizations and individual treatment plans based empirically based interventions.

Participants will learn how to best assess anger problems and how and when to implement the following interventions: 1) motivational enhancement strategies, 2) strategies for establishing a therapeutic alliance with angry patients, 2) strategies for challenging anger eliciting cognitions, 3) exposure interventions, 3) the rehearsal of new assertive behaviors, 4) relevant homework assignments.

Ray DiGiuseppe received his Ph.D. from Hofstra University in 1975.  He was elected a fellow of the American Psychological Association’s divisions of Clinical, School, Psychotherapy, and Family Psychology, the Association for Psychological Science, and the Association for Behavioral and Cognitive Therapies.  He has published extensively on anger and his works include Understanding Anger Disorders, the Anger Disorders Scale, and the Anger Regulation and Expression Scale. He has also published extensive in REBT and co-authored the Practitioners Guide to Rational Emotive Behavior Therapy. He served as president of the Association of Behavioral and Cognitive Therapies and the Society for the Advancement of Psychotherapy (Division 29 of the American Psychological Association). He is presently Professor of Psychology at St. John's University in New York, and Director of Education at the Albert Ellis Institute. He is presently conducting a meta-analytic review of anger treatment studies.

References
DiGiuseppe, R. & Tafrate, R. (2007). Understanding Anger Disorders. New York: Oxford University Press.
DiGiuseppe, R., & Tafrate, R. (2010). Anger: How it differs from other emotions. In Irving Weiner & Ed Craighead (Eds.). Corsini’s Encyclopedia of Psychology. New York: John Wiley & Sons.
DiGiuseppe, R. (2013). Assessment and treatment of anger as a clinical problem. In G. P. Koocher, J. C. Norcross, B. A. Greene (Eds.), Psychologists' desk reference (3rd Ed.) (pp. 210-214). New York, NY US: Oxford University Press.
Lee, A., & DiGiuseppe, R. (2017). Anger and aggression treatments: a review of meta-analyses. Current Opinion in Psychology, 19, 65–74. doi.org/10.1016/j.copsyc.2017.04.004


 

Cognitive Therapy for Post Traumatic Stress Disorder
Anke Ehlers, University of Oxford

Workshop 3 - More information...

Treatment guidelines recommend trauma-focused cognitive behavioural treatments as treatments of choice for posttraumatic stress disorder (PTSD). Cognitive Therapy for PTSD is a version of these treatments that builds on Ehlers and Clark’s (2000) cognitive model of PTSD. This model suggests that people with PTSD perceive a serious current threat that has two sources, excessively negative appraisals (personal meanings) of the trauma and / or its sequelae and characteristics of trauma memories that lead to reexperiencing symptoms. The problem is maintained by cognitive strategies (such as thought suppression, rumination, safety-seeking behaviours) that are intended to reduce the sense of current threat, but maintain the problem by preventing change in the appraisals and trauma memory, and / or lead to increases in symptoms.

Cognitive Therapy for PTSD has been shown to be highly effective and acceptable to patients (Duffy et al., 2007; Ehlers et al. 2003, 2005, 2014, 2016; Gillespie et al., 2002; Smith et al., 2007). It has three goals. First, the idiosyncratic personal meanings are identified and changed. Therapeutic techniques include identification of hot spots during the trauma and associated meanings, socratic questioning, and behavioural experiments. Second, the trauma memory is elaborated.  Idiosyncratic personal meanings of the trauma are updated with information that corrects impressions and predictions at the time, using a range of techniques. In stimulus discrimination training, the patient learns to discriminate triggers of reexperiencing symptoms from the stimuli that were present during the trauma. Third, the patient experiments with dropping maintaining behaviours.

Posttraumatic stress disorder is commonly seen in clinical practice. The workshop will equip participants with clinical tools to address the disabling reexperiencing symptoms that characterise this disorder. Participants will learn to

  • Identify important characteristics of trauma memories and their triggers,
  • Identify key processes that maintain PTSD,
  • Develop an idiosyncratic version of the treatment model with their patients,
  • Identify ways of changing problematic meanings in PTSD.
  • Identify ways of integrating changed meanings into trauma memories.

Anke Ehlers is a Wellcome Trust Principal Research Fellow and Professor of Experimental Psychopathology at the Department of Experimental Psychology, University of Oxford, UK. She has received several awards for her work on posttraumatic stress disorder, including the Award for Distinguished Scientific Contributions to Clinical Psychology, American Psychological Association and the Wilhelm Wundt- William James Award, awarded jointly by the European Federation of Psychology Associations and the American Psychological Foundation

References
Ehlers, A., & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345.
Ehlers, A., Hackmann, A., Grey, N, Wild, J., Liness, S., Albert, I., Deale, A., Stott, R., & Clark, D. M. (2014). A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy. American Journal of Psychiatry, 171, 294-304.
Ehlers, A. & Wild, J. (2015). Cognitive Therapy for PTSD: Updating memories and meanings of trauma. In U. Schnyder and M. Cloitre (Eds.), Evidence based treatments for trauma-related psychological disorders (pp. 161-187). Cham, Switzerland: Springer.


 

Warranted or unwarranted?  Smart use of DBT Emotion Regulation Skills to address Intense Emotion
Michaela Swales, Bangor University

Workshop 4 - More information...

Dialectical Behaviour Therapy is a well-established efficacious treatment for clients with a diagnosis of borderline personality disorder and high-risk suicidal behaviours (Stoffers, et al, 2013).  Recently, aspects of DBT, e.g. the skills training component, have been applied successfully with clients with less severe problems. DBT focuses on the affect regulation function of maladaptive behaviours such as self-harm, drug misuse and binge eating teaching clients a range of skills to decrease unwanted emotions.  Central to deciding on which skills to use is discerning whether an emotion and its intensity is warranted or unwarranted in any given situation.  Skilled DBT therapists aid clients in these crucial determinants to select appropriate skills.  This workshop will review the emotion regulation skills from DBT (Linehan, 2015 a &b) focusing on how to coach and teach these skills effectively to clients.

Workshop participants will learn how to more clearly identify specific emotions in therapy and how to target specific features of the emotional response for change. They will learn
1.            How to use the DBT model of emotion as a basis for skill selection
2.            Understand when an emotion is warranted or unwarranted
3.            How to teach two key DBT emotion regulation skills to clients in ‘Check the Facts’ and ‘Opposite-              to-emotion action’.

Michaela Swales PhD is a Consultant Clinical Psychologist with BCUHB and Reader in Clinical Psychology on the North Wales Clinical Psychology Programme, School of Psychology, Bangor University.  She trained in Dialectical Behaviour Therapy in Seattle in 1994 / 95 with Marsha Linehan and for twenty years ran a clinical programme for suicidal young people in an inpatient service.  She was one of the founder members of the UK DBT Training Team became Director of the Training Team in 2002.  She has trained more than a thousand professionals in DBT, seeding over 400 programmes, in both the UK and further afield.  She is the author with Heidi Heard PhD of Dialectical Behaviour Therapy: Distinctive Features (2009; 2016) by Routledge and Changing Behavior in DBT: Problem-Solving in Action published by Guilford in November 2015.  She is editor of the Oxford Handbook of DBT.  She, along with Dr Heard, won the Cindy Sanderson Outstanding Educator Award at the International Society for the Improvement and Training of DBT at their conference in New York in 2009.  

References
Heard, H. & Swales, M. (2015).  Changing Behavior in DBT: Problem-Solving in Action.  New York: Guilford Press
Linehan, M.M. (2015a) DBT Skills Training Manual.  New York: Guilford Press.
Linehan, M.M. (2015b) DBT Skills Training Handouts and Worksheets.  New York: Guilford Press.
Swales, M. & Heard, H. (2017) Dialectical Behaviour Therapy: The Distinctive Features Series.  Second Edition. London: Routledge


 

How to Build Wellbeing and Positive Emotions in Depression
Barney Dunn, University of Exeter

Workshop 5 - More information...

The primary focus in evidence based psychotherapies 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 acute depression. Residual anhedonia symptoms out of episode make individuals more likely to relapse in the future. Moreover, most clients come to therapy wanting to build wellbeing a – sense of meaning, pleasure and social connection – in addition to reducing their symptoms of depression.

This workshop will focus on ways to integrate principles and techniques of Augmented Depression Therapy (ADepT) into CBT and BA practice to more effectively repair anhedonia and build wellbeing in depression. ADepT has been co-designed alongside clients and clinicians to systematically build positivity. It targets (potentially transdiagnostic) mechanisms identified in basic science research that inhibit wellbeing and maintain anhedonia.

ADepT helps clients set and work towards valued life goals, then formulate and overcome how their depression stops them from thriving (making the most of potential opportunities) and being resilient (overcoming potential challenges) along the way. ADepT also supports clients to develop and follow a long term wellbeing plan to help them continue to flourish after therapy has completed. The workshop will give an overview of the rationale and evidence behind the ADepT approach, then discuss ways ADepT principles, techniques, and therapeutic style can be integrated into current practice in a range of settings (including low intensity and high intensity IAPT services and secondary care). The workshop will assume basic familiarity with current CBT and BA protocols for treating depression.

Better targeting anhedonia and building wellbeing is likely to lead to improved acute and long term treatment outcomes when using CBT to treat depression and related depression. The Key learning objectives are that by the end of the workshop, participants will have learnt how to:

  • Present a wellbeing focused rationale to clients
  • Co-set values consistent goals with clients
  • Identify and formulate key mechanisms that block thriving (making the most of an opportunity) and resilience (overcoming challenges) in clients
  • Use a range of techniques to develop healthy alternative coping that maximises reliance and thriving (including optimising key techniques in CBT
  • Set a long term wellbeing plan for clients to follow after therapy to sustain positive outcomes
  • Modify their therapeutic style to promote positive communication without being “PollyAnna-ish”
  • Be introduced to ways to practice these techniques on themselves

Barney is a research and clinical psychologist, who works as an Associate Professor at the University of Exeter Mood Disorders Centre. He is currently funded by an NIHR Career Development Fellowship to develop Augmented Depression Therapy (ADepT), a treatment targeting overcoming anhedonia and building wellbeing in depression. He leads a broader research programme characterising positivity deficits in depression and developing novel ways to build positivity in evidence based psychotherapies. He completed the Beck Scholar programme at the Beck Cognitive Therapy Institute in Philadelphia in 2013 and is accredited by the BABCP and Academy of Cognitive Therapy. He co-directs the AccEPT clinic, an NHS commissioned research and development psychological therapies service at the Mood Disorders in Exeter. He is a regular trainer, teacher and supervisor in CBT and related approaches(see: http://psychology.exeter.ac.uk/staff/index.php?web_id=Barney_Dunn)

 

References
Dunn, B. D., &  Roberts H (2016). Improving the capacity to treat depression using talking therapies: Setting a positive clinical psychology agenda. In Wood A, Johnson J (Eds.) Handbook of Positive Clinical Psychology.
Dunn, B. D. (2017). Opportunities and challenges for the emerging field of positive emotion regulation: a commentary on the special edition on positive emotions in psychopathology. Cognitive Therapy and Research, 41, 469-478
Dunn, B.D. (2012). Helping depressed clients reconnect to positive emotion experience: Current insights and future directions. Clinical Psychology & Psychotherapy, 19, 326-340.


 

CBT for Eating Disorders: Developing Core Skills for Evidence-based Treatment
Hannah Turner, Southern Health NHS Trust & Glenn Waller, University of Sheffield

Workshop 6 - More information...

Evidence-based cognitive-behaviour therapy (CBT-ED) is the therapy that is recommended most widely for eating disorders under the recent National Institute for Health and Care Excellence guidelines (NICE, 2017). It is the primary therapy for treating non-underweight adults, one of the recommended therapies for underweight adults, and applicable for some younger cases. However, CBT is routinely applied poorly with such cases, if at all. In part, this is because clinicians do not know the core techniques and how to apply them effectively: in part, it is because we avoid asking patients to undertake the hard work that is necessary. This workshop will detail the evidence for CBT-ED, the structure of this therapy, and why we fail to apply it appropriately. The majority of the workshop will be dedicated to skills training. Participants will be shown a range of CBT-ED techniques in action and will be encouraged to undertake those techniques in order to learn how to apply them appropriately.

This workshop is designed for clinicians who want to be able to effectively deliver evidence-based CBT-ED in routine clinical settings. By the end of the workshop participants should be able to:

1.            How to handle the first few sessions to encourage maximum short- and long-term          benefits – particularly changing central cognitions, behaviours and emotions, and         managing non-negotiables
2.            Exposure therapy related to changes in eating (and weight, where appropriate)
3.            Behavioural experiments used to change cognitions
4.            Cognitive restructuring to address different levels of cognitions
5.            Exposure therapy related to wider emotional concerns
6.            Body image treatment, based on identifying and targeting specific maintaining factors
7.            Ending therapy appropriately

Hannah Turner is a Consultant Clinical Psychologist and Clinical Lead of the Southern Health NHS Foundation Trust Eating Disorders Service. She is an experienced clinician who has worked in the eating disorders field for nearly 20 years. She also continues to have a keen interest in research, her recent work focusing on predictors of treatment outcome in CBT for eating disorders. She has co-authored over 40 peer-reviewed papers and is a BABCP accredited therapist and supervisor. She was a member of the recent NICE Eating Disorders Guideline Development Group (2017). 

Glenn Waller is Professor of Clinical Psychology at the University of Sheffield, UK. His clinical and academic specialism is evidence-based CBT for eating disorders, with a particular emphasis on effective treatment in routine clinical settings. He has published over 260 peer-reviewed papers, 20 book chapters and two books in the field, and regularly presents workshops at national and international meetings. He is past president of the International Academy for Eating Disorders, is an Associate Editor of the International Journal of Eating Disorders and is on the editorial board of Behaviour Research and Therapy. He was a member of the NICE Eating Disorders Guideline Development Group, responsible for the 2017 update to the eating disorders guideline.

References
Fairburn, C. G. (2009). Cognitive behavior therapy and eating disorders. New York NY: Guilford
Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V., & Russell, K. (2007). Cognitive behavioral therapy for eating disorders: A comprehensive treatment guide. Cambridge, UK: Cambridge University Press.


 

A Cognitive Interpersonal Approach to Staying Well after Psychosis.
Andrew Gumley, University of Glasgow

Workshop 7 - More information...

This workshop will outline a cognitive interpersonal approach to staying well after psychosis. The complexity of recurrence of psychosis is poorly understood and the recognition the contributions of service responses is often neglected. The workshop will focus on how to formulate individual cognitive (trauma, fear of relapse, stigma and shame), interpersonal (attachment, social support, help seeking) and systemic (family and staff appraisals of and responses to recurrence) factors. Furthermore, contemporary approaches to preventing recurrence tend to emphasise risk or threat-based strategies such as early warning signs.

This workshop will focus on the cognitive, interpersonal and systemic factors involved in emotional recovery and vulnerability to the recurrence of psychosis. The workshop will outline how cognitive interpersonal approaches can provide a framework for developing individually tailored strategies for case formulation, recovery and staying well that primarily focus on emotional and interpersonal adaptation to psychosis. This approach incorporates:

1.            A focus on the experience of psychosis as a source of trauma leading to fear of recurrence,
2.            The development of interpersonal perspective on help seeking and emotional regulation,
3.            Understanding systemic and organisational responses to the treat of recurrence,
4.            Integrating cognitive interpersonal formulation into optimising service responses to recurrence.

Andrew Gumley is Professor of Psychological Therapy in the Institute of Health and Wellbeing at the University of Glasgow. Andrew is also Honorary Consultant Clinical Psychologist in ESTEEM Glasgow, a service for young people aged between 16 and 35 who have experienced their first episode of psychosis. Andrew’s main clinical and research interests are in emotional recovery and prevention of recurrence. Andrew was Chief Investigator for first was a randomised controlled trial of Cognitive Therapy for the prevention of relapse (CSO)). He is currently Chief Investigator for the NIHR / NHMRC funded EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement and Recovery) study, a cluster randomised controlled trial of digital technology to promote recovery and recurrence prevention.


 

Thinking Effectively About Mood Swings (TEAMS) - Cognitive Therapy for Mood Swings and Bipolar Disorders
Sara Tai, University of Manchester

Workshop 8 - More information...

Most people diagnosed with bipolar disorder experience ongoing problems outside of episode including sub-clinical symptoms of hypomania, depression (Vieta et al., 2010), anxiety disorders (Goes et al., 2012), and disturbances in quality of life (Bonnin et al., 2012). To date, psychological interventions have demonstrated significant but modest effects (e.g. Richardson, 2010 and indicate that despite treatment, patients continue experiencing significant difficulties. Developing alternative approaches to managing bipolar disorders is essential.

This interactive, experiential workshop provides a comprehensive introduction to a new CBT approach known as TEAMS (Think Effectively About Mood Swings) based on an empirically supported model (Mansell et al., 2007). TEAMS is a transdiagnostic approach that enables the targeting of current problems, such as depression and anxiety, by developing a shared understanding of how conflicting thinking styles and behaviours maintain and escalate current symptoms. Treatment aims to increase tolerance to internal states perceived to be problematic by helping individuals focus on controlling important life goals as opposed to mood states.

This workshop is for clinicians with ranging experience and aims to build confidence, draw on existing skills, whilst highlighting specific factors that attendees might need to consider when working with this client group. The approach can be used with anyone who experiences problematic mood swings, including people who present with clinically relevant symptoms but do not meet diagnostic criteria for bipolar disorder. A contemporary, process-oriented and experiential approach to cognitive therapy will be illustrated; for example, use of imagery and targeting processes such as worry, rumination and selective attention. The focus is on dealing with current problems and promoting long-term recovery, rather than merely preventing relapse.

The workshop will
•             Develop understanding of the nature of problems associated with bipolar disorders
Consider current approaches to treatment and potential difficulties
Understand the TEAMS cognitive model as a transdiagnostic framework (Mansell,           Morrison, Reid, Lowens & Tai, 2007)
•             Learn techniques to promote the participation and engagement of patients;
•             practice key therapeutic techniques based on the model including developing formulations,       normalising, questioning techniques to facilitate the description, acceptance and tolerance of             internal states, and increasing mental flexibility
•             utilise case studies that highlight potential difficulties and how they can be overcome.
•             consider and explore the role of conflicting extreme personal beliefs about internal states          and
•             facilitate the development of a ‘healthy’ self
•             develop ways of delivering cognitive therapy flexibly and adaptively using transdiagnostic            methods to ensure each patient receives therapy specific to their individual needs.

Dr Sara Tai is Senior Lecturer in Clinical Psychology at Manchester University. She is an experienced practitioner, researcher, and trainer of CBT for psychosis, bipolar disorders and mood swings. She provides supervision and workshops internationally and is involved in research on psychoses and bipolar disorders in China, USA, Europe, and the UK. She has recently conducted a randomized controlled trial of TEAMS therapy for bipolar disorders.

References
Mansell, W., Morrison, A.P., Reid, G., Lowens, I. & Tai, S. (2007) The interpretation of and responses to changes in internal states: an integrative cognitive model of mood swings and bipolar disorder. Behavioural and Cognitive Psychotherapy, 35, 515-541.
Mansell, W., Morrison, A.P., Reid, G., Lowens, I. & Tai, S. (2007b). An Integrative Cognitive Model of Mood Swings and Bipolar Disorders: An Illustrative Case Study. Behavioural and Cognitive Psychotherapy, 35: Supplementary materials at journals.cambridge.org
Mansell, W., Brawn, P., Griffiths, R., Silver, B., & Tai, S. J. (2015). Bipolar disorders and problematic mood swings. The Complete CBT Guide for Depression and Low Mood. Little Brown. eScholarID: 231495.


 

Cognitive Therapy for Different PTSD Presentations in Children and Adolescents
Richard Meisser Stedman, University of East Anglia

Workshop 9 - More information...

Cognitive mechanisms have been shown to be associated with acute, chronic and multiple trauma PTSD in children and young people (CYP). In particular, trauma-related appraisals have been found to be some of the strongest correlates or predictors of PTSD in this age group. Such appraisals, as well as other aspects of CYP’s processing of traumatic experiences (e.g. their memories, how they are coping with their PTSD symptoms) have been tackled in adult studies of cognitive therapy for PTSD (CT-PTSD). Four CBT PTSD treatment studies in CYP have shown that changing trauma appraisals is important for improved symptoms. In this workshop I will be outlining how the cognitive model of PTSD can be applied successfully to CYP, with very concrete treatment targets for different PTSD presentations, i.e. in the acute phase, when PTSD has become chronic, and when there have been multiple trauma exposures. My hope is that attendees will be come away confident in approaching this often demanding but rewarding work. The key learning objectives for the workshop are:

1.            Understand how cognitive theory can explain the onset and maintenance of PTSD in children and young people (CYP), and how to use this theory to develop a formulation.
2.            Know how to use outcome and process measures to monitor progress through therapy and inform formulation
3.            Understand how to use cognitive therapy techniques to address peri-traumatic and post-traumatic appraisals that may be maintaining post-traumatic stress and low mood, and update trauma memories.

Richard Meiser-Stedman is a clinical psychologist and a Reader in Clinical Psychology at the University of East Anglia. He is also currently a NIHR Career Development Fellow.

References
Smith, P., Yule, W., Perrin, S., Tranah, T., Dalgleish, T., & Clark, D. M. (2007). Cognitive-behavioral therapy for PTSD in children and adolescents: a preliminary randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 46(8), 1051-1061.
Meiser‐Stedman, R., Smith, P., McKinnon, A., Dixon, C., Trickey, D., Ehlers, A., Clark, D.M., Boyle, A., Watson, P., Goodyer, I. & Dalgleish, T. (2017). Cognitive therapy as an early treatment for post‐traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action. Journal of Child Psychology and Psychiatry, 58, 623-633.


 

Compassion Focused Therapy for Teens
Mary Welford, Compassion in Mind

Workshop 10 - More information...

Compassion Focused Therapy (CFT) was developed by Paul Gilbert, OBE, as a means of addressing psychological difficulties underpinned by shame and self-criticism.  The model draws on social, evolutionary (especially attachment theory) and neurophysiological science to understand emotional regulation and our basic social motivational systems.  Central to the model is recognition that our evolved brain’s new competencies, such as reasoning, reflection, metallisation and ‘sense of self’, can prove to be problematic when influenced by our ‘old’ brain’s capacities.  In addition our ‘old brain’ can recruit the capacities of our new brain and be potentially very destructive for both ourselves and others.  CFT highlights the benefit of mindfully developing compassion, thus activating our affiliative/soothing system, to balance our affect regulating systems, particularly in response to threat.
The ‘transdiagnositic’ approach now has a growing evidence base.   In recent years the application of compassion based approaches has been used with NHS staff teams, the armed forces, business settings and within education.  This is partially due to recognition that such environments are often largely threat and target focused.

The workshop will introduce delegates to the theory and practice of CFT for teens and provide some practical ideas that can be used straight away (both personally and professionally).
To gain a brief introduction to Compassion Focused Therapy
To build awareness of how CFT theory relates to teenagers
To develop ideas of how the theory can be put into practice with teenagers

Mary Welford is a Consultant Clinical Psychologist based in the South West of England. Between 1998-2005 she held a number of positions for the BABCP and has been involved in a range of CBT trials whilst based in Manchester (which she still loves ;-) Mary is a founding member of the Compassionate Mind Foundation and was Chair for a 4 year term. She has authored of The Compassionate Mind Approach to Building Your Self Confidence in 2012 and Compassion Focused Therapy for Dummies in 2016.

 

The Therapeutic Relationship in Cognitive Behaviour Therapy
Stirling Moorey, South London and Maudsley NHS Trust

Workshop 11 - More information...

This workshop will review the evidence base concerning 3 aspects of the therapeutic relationship. Firstly, the role of the core conditions of warmth, genuineness and empathy will be discussed and their effect on outcome evaluated. Secondly, the place of the working alliance, in CBT more specifically collaborative empiricism, will be discussed. Thirdly, a cognitive-behavioural perspective on 'transference' and 'countertransference' will be given, using the model of interpersonal schemas. Clinical implications of the theoretical and empirical aspects of the therapeutic relationship will be presented with opportunities to apply them to participants' own practice.

This workshop will allow participants to explore their cognitive and emotional reactions to difficult patients and to experiment with alternative ways of approaching these patients. A model for conceptualising the unhelpful patterns of interaction that we can get into with these patients will be presented and participants will be able to consider how they might escape from therapy-inhibiting interpersonal cycles. The workshop will:

1. To understand the relative contribution of 'non-specific' therapist factors and specific CBT interventions on outcome.
2. To use an experiential empathy exercise to change our relationship to a 'heartsick' patient.
3. To understand the place of collaborative empiricism in effective CBT.
4. To understand how 'transference' and 'countertransference' can be described within a CBT framework and how to understand and manage the interaction of therapist and patient beliefs

Stirling Moorey is Consultant Psychiatrist in CBT at SLaM and visiting senior lecturer at the Institute of Psychiatry, Psychology and Psychotherapy (IOPPN). He has been teaching and supervising CBT for over 30 years and was a co-founder of the IOPPN PgDip in CBT. He is author of Moorey S (2014) “Is it them or is it me?” Transference and countertransference in CBT In Whittington A & Grey N Eds. How to Become a More Effective CBT Therapist: Mastering Metacompetence in Clinical Practice (Wiley). He is co-editor (with Dr Anna Lavender) of the forthcoming SAGE publication 'The Therapeutic Relationship in CBT'.

References
Dattilio, F. M., & Hanna, M. A. (2012). Collaboration in cognitive-behavior therapy. Journal of Clinical Psychology: In Session, 68, 146–158.
Norcross, J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II [Special Issue]. Psychotherapy, 48(1).
Moorey S (2014)  “Is it them or is it me?” Transference and countertransference in CBT In Whittington A & Grey N Eds. How to Become a More Effective CBT Therapist: Mastering Metacompetence in Clinical Practice (Chichester: Wiley).


 

Using the Assessment of Core CBT Skills (ACCS) to Assess CBT Competences
Freda McManus, Stirling University

Workshop 12 - More information...

The workshop will address the why, what and how of assessing CBT competence. First, in relation to the assessment of CBT competence in general: What is CBT competence? Why should we assess CBT competence? And how should we go about assessing CBT competence?

Effective assessment of Cognitive Behaviour Therapy (CBT) competence is crucial to the successful development of CBT interventions and services; and to the successful dissemination of evidence-based CBT protocols into routine clinical practice. However, a lack of consensus about how CBT competence should be assessed has resulted in the use of numerous different methods, many of which have been widely criticised. This workshop will examine the advantages and disadvantages of the various methods for assessing CBT competence within Miller's (1990) framework for assessing clinical skill, in the context of ‘evidence-based training’ (Ravoshik & McManus, 2010) before going on to introduce a new measure for assessing CBT competence – The Assessment of Core CBT Skills (ACCS – Muse, McManus, Rakovshik & Thwaites, 2017).

Second, in relation to the Assessment of Core CBT Skills (ACCS), an observation-based scale which supervisors can use to deliver formative and summative feedback within supervision, the workshop will outline:

•             What is the ACCS scale is?
•             Why was the ACCS developed?
•             How was the ACCs developed?
•             How the ACCS hold up to scrutiny in comparison to existing measures (CTS-R) in terms of            validity, reliability and usability?
•             How can the ACCS be used to:  Assess competence? Promote self-reflection? Facilitate                skill-                development within supervision?

This workshop will introduce the ACCS and give participants the opportunity to practice using it.  The day will involve a mixture of presentations and active participation in discussions as well as the opportunity to observe and rate a CBT session on the ACCS. By the end of the workshop attendees should be familiar with and confident in using the ACCS scale and have an understanding of how the scale fits within best-practice guidelines for assessing competence in CBT. See https://www.accs-scale.co.uk/ for more information on the Assessment of Core CBT Skills (ACCS)

Dr Freda McManus is a Consultant Clinical Psychologist and has been the (acting) Director of the Oxford Cognitive Therapy Centre, and a Clinical Research Fellow in the University of Oxford’s Department of Psychiatry. She is currently Joint Course Director of the University of Stirling / Dundee MSc in Psychological Therapies programme. Freda has worked clinically for 20 years and has a range of experience in developing and evaluating CBT interventions for anxiety disorders as part of research teams at the University of Oxford and at the Institute of Psychiatry, Kings College, London. She has published widely in both clinical and academic texts, in the areas of CBT for anxiety disorders, and on training healthcare professionals to effectively deliver CBT interventions, and in assessing competence in delivering CBT interventions.

References
Muse, K., McManus, F., Rakovshik, S., & Thwaites, R. (2017). Development and
Psychometric Evaluation of the Assessment of Core CBT Skills (ACCS): An Observation-Based Tool for Assessing Cognitive Behavioral Therapy Competence. Psychological Assessment, 29, 542-555.
Muse, K. & McManus, F. (2016). Expert insight into the assessment of competence in cognitive–behavioural therapy: A qualitative exploration of experts' experiences, opinions and recommendations. Clinical Psychology and Psychotherapy, 23, 246-259.
Muse, K. & McManus, F. (2013). A systematic review of methods for assessing competence in cognitive behavioral therapy. Clinical Psychology Review, 33, 484499.
Rakovshik, S. & McManus, F. (2010). Establishing evidence-based training in Cognitive Behavioral Therapy: A review of current empirical findings and theoretical guidance. Clinical Psychology Review, 30, 496-516.


 

How to Conduct Single-case Experimental Designs to Guide Treatment
JD Smith, Northwestern University Feinberg School of Medicine, USA

Workshop 13 - More information...

In the current era of evidence-based practice, psychologists and other mental health professionals have increasing accountability to demonstrate the effectiveness of services provided.  Historically, a divide has existed between professional practice and psychological research, particularly in the preference for group comparison designs used for null hypothesis testing, which are impracticable in the majority of applied settings and do very little to reveal how individual clients respond to intervention.  The single-subject experimental design bridges this gap by providing clinician-researchers with a robust, client-centered method for tracking and evaluating improvement using robust and accessible analytic procedures.  In the single-subject experiment, there are three approaches to evaluating whether observed clinical improvement is notable: (1) testing the improvement against the null hypothesis; (2) testing improvement against the criterion measure’s norms; and (3) testing the meaningfulness or clinical significance of the improvement.  This workshop provides an introduction to single-subject experimental designs applicable to real-world clinical situations and a tutorial on how to analyse repeated measurement data, commonly referred to as a time-series, with a freely available software package designed specifically for clinicians and applied clinical researchers.  Case examples are used to illustrate how null hypothesis testing, criterion norms, and meaningfulness approaches can be used together to give a robust depiction of clinical change and its importance.  Last, synthesis methods for aggregating data from multiple single-subject experiments will be discussed, which increase the rigor of this type of research.  An emphasis will be placed on pragmatic designs and data collection methods throughout the workshop.  Participants in this workshop will (a) gain the necessary conceptual and pragmatic knowledge to effectively conduct single-case experiments in their respective clinical settings, (b) be able to use single-subject time-series analytic software, (c) be able to design a sound experiment in order to make valid causal inferences, and (d) appreciate the distinctive contributions of the three approaches to evaluating clinical improvement.  The workshop is intended for practitioners and clinical researchers of all levels desiring to conduct single-case experiments in the study of the effectiveness of psychological services.  The presenter, Dr. J.D. Smith, is a clinical psychologist and methodologist who is well published in this area and regularly conducts workshops for professional psychologists.  Participation requires only introductory knowledge of single-case designs and statistical hypothesis testing.   Attendees are encouraged to bring questions regarding how they might conduct this research in their clinical practice or research setting.

The methods taught can be used to evaluate the effectiveness of CBT interventions delivered in everyday clinical practice. The key learning objectives of the workshop are:
1.            Gain the necessary conceptual and pragmatic knowledge to effectively conduct single- case       experiments in their respective clinical settings
2.            Be able to use single-subject time-series analytic software
3.            Be able to design a sound single-subject experiments
4.            Appreciate the distinctive contributions of the three approaches to evaluating clinical    improvement

J.D. Smith, Ph.D. is assistant professor in the Departments of Psychiatry and Behavioral Sciences, Preventive Medicine and Pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Illinois. He is also Assistant Director of the Center for Prevention Implementation Methodology for Drug Abuse and HIV, a Center of Excellence funded by the National Institute on Drug Abuse of the National Institutes of Health. His research focuses on translating evidence-based interventions to real-world service delivery systems and developing implementation science methods for healthcare systems change. He is principal investigator of two effectiveness-implementation hybrid trials evaluating a family-based program to prevent pediatric obesity and excess weight gain through primary healthcare. These projects are funded by the Centers for Disease Control and Prevention and the United Stated Department of Agriculture. He is co-investigator on multiple projects with federal and foundation funding support. Dr. Smith received his Ph.D. in clinical psychology at the University of Tennessee Knoxville in 2011 and he completed a predoctoral internship at the University of Colorado School of Medicine and postdoctoral research fellowships at the Prevention Science Institute at the University of Oregon and at the Institute for Research and Education Advancing Children’s Health (REACH) at Arizona State University. He has authored more than 50 peer-reviewed journal articles and book chapters; is a Fellow of the Implementation Research Institute; is incoming Associate Editor of Prevention Science; and is formerly Associate Editor of the Journal of Personality Assessment.

References
Smith, J. D. (2012). Single-case experimental designs: A systematic review of published research and current standards. Psychological Methods, 17(4), 510-550. doi:10.1037/a0029312
Smith, J. D., Eichler, W., Norman, K., & Smith, S. R. (2015). The effectiveness of a therapeutic model of assessment for psychotherapy consultation: A pragmatic replicated single-case study Journal of Personality Assessment, 97(3), 261–270. doi:10.1080/00223891.2014.955917
Borckardt, J. J., Nash, M. R., Murphy, M. D., Moore, M., Shaw, D., & O'Neil, P. (2008). Clinical practice as natural laboratory for psychotherapy research. American Psychologist, 63, 1-19. doi:10.1037/0003-066X.63.2.77


 

Half day Workshop (13.45 – 17.00)

Exposure therapy in the 21st century
Michelle Craske, University of California, Los Angeles, USA

Workshop 14 - More information...

The therapeutic strategy of repeated exposure is effective for fears and anxiety disorders, but a substantial number of individuals fail to respond. Translation from the basic science of inhibitory extinction learning and inhibitory regulation offers strategies for increasing response rates to exposure therapy. This workshop will present the application of these strategies, including prediction error correction (‘violation of expectancy’), variability across stimuli and contexts to enhance generalization, interference with hippocampal activation to enhance context generalization, bridging techniques to retrieve exposure memories in novel contexts, induction of positive valence, and linguistic processing (‘affect labeling’) of feared stimuli.

Tailor methods for conducting exposure therapy to facilitate response rates and reduce return of fear. The key learning objectives of the workshop are:
1.            Understand latest developments in extinction learning and their relevance to exposure               therapy
2.            Understand latest developments in inhibitory regulation and their relevance to exposure            therapy
3.            Understand methods for optimizing inhibitory learning during exposure therapy and its                retrieval following exposure therapy
4.            Understand methods for augmenting inhibitory regulation during exposure via affect    labelling.

Michelle G. Craske, Ph.D., is Distinguished Professor of Psychology, Psychiatry and Biobehavioral Sciences, Director of the Anxiety and Depression Research Center, and Associate Director of the Staglin Family Music Center for Behavioral and Brain Health, at the University of California, Los Angeles.  She is a leader of the UCLA Depression Grand Challenge.  She has published extensively in the area of fear, anxiety and depression.  In particular, she investigates neurophysiological, environmental, cognitive and behavioral correlates and risk factors for anxiety and depression using longitudinal designs, fear extinction mechanisms and their neural underpinnings for exposure-based therapies for anxiety, reward sensitivity training for anhedonia, and implementation of treatments for anxiety and depression in non-research settings. She is Editor-in-Chief for Behaviour Research and Therapy. 

References
Craske, M.G., Treanor, M., Conway, C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.
Craske, M.G., Hermans, D., & Vervliet, B. (in press). State of the art and future directions for extinction as a translational model for fear and anxiety. Philosophical Transactions B