1. Cognitive Therapy of Resistance
Robert L. Leahy, American Institute for Cognitive
NYC and Weill-Cornell Medical School, USA
Many patients do not readily respond to standard
cognitive-behavioural interventions, confronting the therapist with impasses
that are difficult to resolve. In this workshop a multi-dimensional model
of resistance will be presented. These dimensions include resistance due
to validation demands, emotional processing, self-consistency, schematic
processing, moralistic thinking, victim roles, risk-aversion, and self-handicapping.
Validation resistance involves demands for empathy and agreement that
may conflict with the change-model advocated in cognitive therapy. Emotional
processing problems may occur when the individual either blocks the experience
of an emotion, views emotions as incomprehensible to self or others, rejects
the complexity of emotions, believes that emotions must be controlled,
or misattributes emotions to other causes. Self-consistency needs are
reflected in over-commitment to past decisions-or sunk-costs. Schematic
processing may result in resistance due to the biasing effect of information
search, retrieval and evaluation and to the impermeability of personal
schemas. Moralistic thinking may result in resistance if the individual
endorses overly rigid ideas of obligations for self and others. Victim
roles often result in resistance if the patient believes that he or she
is an innocent victim entitled to sympathy, self-pity, apologies from
others or revenge. Risk-aversion may affect resistance to change if the
patient views himself as needing complete certainty and control, as having
limited current and future resources, and as likely to have a receding
reference point for success and an early stop-out rule. Finally, individuals
may utilize self-handicapping strategies in order to avoid direct evaluations
of the self or perceived exposure to loss.
A brief theoretical model will be reviewed for
each dimension and case conceptualizations for specific examples of resistance
will be presented. The participant will learn how to evaluate and conceptualize
different kinds of resistance in cognitive-behavioral therapy and how
to utilize a variety of cognitive, behavioral and interpersonal strategies
and techniques in dealing with resistance. In addition, we will also examine
the therapist's response to the patient's resistance by reviewing counter-transference
issues. Counter-transference is conceptualized in cognitive and behavioral
terms rather than psychoanalytic terms. We will examine how the therapist
may use the counter-transference as a window into the interpersonal world
of the patient to modify the patient's schemas and resistance to change.
Finally, cognitive therapy interventions will be identified to reduce
the negative emotional and therapeutic impact on the therapist of the
Robert L. Leahy (2001) Cognitive Therapy of Resistance. New York: Guilford.Leahy,
R.L. Decision-making and Mania. Journal of cognitive psychotherapy, 1999
Leahy, R.L. Strategic Self-limitation. Journal of cognitive psychotherapy,
1999 13, 275-293
Leahy, R.L. Sunk-costs and resistance to change. Journal of cognitive
psychotherapy, 2000, 14.
Robert L. Leahy (1996) Cognitive Therapy: Basic Principles and Applications.
Northvale, NJ: Jason Aronson.191-230.
and Treatment of Anxiety Disorders in Youth
Philip C. Kendall, Temple University, USA
The workshop will focus on the provision of information and on skill development
for treating anxiety in children 8 to 14 years of age. Initial discussion
will overview the guiding theory and conceptualization, with the latter
focus being on the specific features of the intervention. The bulk of
the workshop will address the specific skills for problem-focused intervention
to manage anxious arousal, including consideration of the reported outcome
data and the role of parenting practices in the maintenance and treatment
of childhood anxiety.
The workshop will cover: the role of cognition
in child anxiety: defining features of information processing; a theoretical
overview; therapist posture and a temporal model; a specific program for
treating youth with anxiety; coping modelling; contingencies; self-talk;
disclosure; role-plays/exposure; workbooks; relationship factors; considerations
of parenting factors; mediators of success and outcome data.
Participants will acquire information about the
nature and identification of anxiety disorders in children and adolescents.
Participants will acquire skills in the provision of treatment for Generalized
Anxiety Disorder, Social Phobia, and Separation Anxiety Disorder in children.
Participants will be exposed to specific treatment procedures from manual-based
treatments will empirical support of efficacy. Relevant data on the evaluations
of the treatment will be mentioned.
Kendall, P. C. (Ed). (2000). Child & adolescent therapy: Cognitive-behavioral
procedures (2nd ed.) NY: Guilford Press.
Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S., Southam-Gerow,
M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety
disorders: A second randomized clinical trial. Journal of Consulting and
Clnical Psychology, 65, 366-380.
Kendall, P. C. (1994). Treating anxiety disorders in youth: Results of
a randomized clinical trial. Journal of Consulting and Clinical Psychology,
Kendall, P. C. (2000). Childhood disorders. London: Psychology Press.
the Difficult Patient: Transforming Therapeutic Failure into Success
David D. Burns, Stanford University School of Medicine,
In the past two decades, numerous studies have demonstrated that cognitive
and behavioral techniques can help most depressed or anxious patients
in a relatively brief period of treatment. In addition, long-term follow-up
studies suggest that they maintain these gains and have fewer relapses
than patients treated with antidepressant medications. However, not all
patients respond rapidly and some resist treatment. Many of these difficult
patients do not form a positive therapeutic alliance and find it difficult
to collaborate effectively with their therapists. Instead of working hard
to get better, they seem to sabotage the treatment because they feel angry,
mistrustful or unmotivated.
Therapists, too, may feel frustrated, guilty, anxious or overwhelmed when
treating these clients. These negative reactions frequently intensify
the resistance, leading to a vicious cycle. In this workshop, Dr. Burns
will illustrate techniques that can help therapists respond far more effectively
to difficult patients and resolve a wide variety of therapeutic logjams.
Dr. Burns will also discuss how therapists can deal more effectively with
their own negative feelings that may interfere with the therapeutic process.
He will emphasize that these challenging moments in therapy--when failure
seems inevitable and personal feelings of frustration and despair are
the most intense--frequently present important opportunities for personal
growth and for significant therapeutic breakthroughs.
This training program is suitable for psychologists, psychiatrists, nurses,
social workers, addiction counselors, marriage and family therapists,
clergy, mental health technicians, trainees, educators and other mental
health professionals who wish to enhance their therapeutic skills.
David D. Burns, M.D. is a Clinical Associate Professor in the Department
of Psychiatry and Behavioral Sciences at the Stanford University School
of Medicine. His best-selling, Feeling Good: The New Mood Therapy (1980)
has sold over three million copies worldwide and is the book most often
recommended by American and Canadian mental health professionals for depressed
patients.Teaching methods will include didactic presentations as well
as role-plays, clinical exercises and live demonstrations with audience
Antonuccio, D.O., Danton, W.G., & DeNelsky, G.Y. (1995). Psychotherapy
versus medication for depression: Challenging the conventional wisdom
with data. Professional Psychology: Research and Practice, 26, 574-585.
Burns, D.D. (1989; 1990). The Feeling Good Handbook. New York: Plume (paperback).
Burns, D. D., & Nolen-Hoeksema, S. (1992). Therapeutic empathy and
recovery from depression in cognitive-behavioral therapy: A structural
equation model. Journal of Consulting and Clinical Psychology, 60(3),
Burns, D. D., & Spangler, D. (2000). Does psychotherapy homework lead
to changes in depression in cognitive behavioral therapy? Or does clinical
improvement lead to homework compliance? Journal of Consulting and Clinical
Psychology, 68(1): 46 - 59.
Burns, D. D., & Spangler, D. (in press). Do changes in dysfunctional
attitudes mediate changes in depression and anxiety in cognitive behavioral
therapy? Behavior Therapy.
Scogin, F., Jamison, C., and Gochneaut, K. (1989). The comparative efficacy
of cognitive and behavioral bibliotherapy for mildly and moderately depressed
older adults. Journal of Consulting and Clinical Psychology, 57, 403-407.
Assessment and Treatment
Raymond W. Novaco, University of California, Irvine,
Providing clinical services for people having recurrent anger problems
is a challenging clinical enterprise. This turbulent emotion, ubiquitous
in everyday life, is a feature of a wide range of clinical disorders.
It is commonly observed in various personality, psychosomatic, and conduct
disorders, in schizophrenia, in bipolar mood disorders, in organic brain
disorders, in impulse control dysfunctions, and in a variety of conditions
resulting from trauma. The central problematic characteristic of anger
in the context of such clinical conditions is that it is "dysregulated"
-- that is, its activation, expression, and experience occur without appropriate
controls. Because anger is a common precursor of aggressive behaviour,
it may be recognized as a salient clinical need, while at the same time
be unsettling for mental health professionals to engage as a treatment
focus. Anger assessment itself presents many challenges, because of reactivity
to the testing situation and the multi-dimensionality of anger. Effectively
targeting anger treatment, as well as ascertaining therapeutic gains hinges
on assessment proficiency.
The workshop will present psychometric, interview, and staff-rated methods
for assessing anger as a clinical problem. Issues of validity will be
delineated, and recommendations for clinical service strategy will be
given. Among the new topics to be covered are assessing anger on admissions
units of psychiatric facilities, in preschool and school-aged children
exposed to violence in the home, and the anger levels of female patients.
Participants will also be shown an interview method for assessing readiness
for anger treatment and given opportunity for practice.
Getting treatment engagement with chronically anger people presents multiple
challenges, especially if they are seriously disordered and historically
assaultive. Such patients are often avoided by clinicians because of their
treatment-resistant characteristics and because of the risks faced by
the clinician in seeking to treat them. Advances in cognitive-behavioural
anger treatment will be presented, having demonstrated efficacy with patients
in secure hospitals, patients with developmental disabilities, and a variety
of community outpatients, including clients having severe posttraumatic
stress disorder. Core themes arising in the treatment process and ways
of obtaining leverage for change through a "preparatory phase"
will be presented. Key components of the cognitive-behavioural approach
to severe anger problems will be described, with some demonstration. Extensions
from individual anger treatment to group-based anger management will be
presented, along with assault risk reduction strategies for clinicians.
The format for the workshop will be didactic and experiential.
Novaco, R. W. (1994). Anger as a risk factor for violence among the mentally
disordered. In J. Monahan & H. Steadman (Eds.), Violence and mental
disorder: Developments in risk assessment. Chicago: University of Chicago
Novaco, R. W. and Chemtob, C. M (1998). Anger and trauma: Conceptualization,
assessment and treatment. In V. M. Follette, J. I. Ruzek, & F. R.
Abueg (Eds.), Cognitive behavioral therapies for trauma. New York: Guilford.
Novaco, R. W., Ramm, M., & Black, L. (2000). Anger treatment with
offenders. In C. R. Hollin (Ed.), Handbook of offender assessment and
treatment. Chichester: John Wiley
Imagery to Enhance the Effectiveness of Exposure and Cognitive Restructuring
in Treating Victims of Physical Assault and Abuse.
Mervin R. Smucker, Medical College of Wisconsin Cognitive
In recent years, cognitive-oriented clinicians and theorists (e.g. Beck,
Foa) have expanded the definition of cognition to include visualizations
(imagery) as well as verbalizations (thoughts). As such, imagery-based
interventions have been increasingly applied in the cognitive treatment
of clinical disorders, especially with individuals suffering from posttraumatic
stress and related anxiety disorders where the distressing affect is directly
linked to the individual's recurring disturbing images.
Through instructional video demonstrations, experiential exercise, case
examples, lecture, and discussion, this workshop will demonstrate the
use of imagery as a primary therapeutic agent to access, challenge, and
modify assault-related cognitions (e.g., memories, flashbacks, attributions,
schemas) with victims of physical violence. Particular focus will be on
how to integrate imaginal exposure, mastery imagery, and self-nurturing
imagery, together with secondary cognitive processing and schema modification,
in decreasing physiological arousal, eliminating recurring traumatic flashbacks
and memories, replacing victimization imagery with mastery imagery, modifying
assault-related beliefs, creating more adaptive schemas, and developing
an enhanced capacity to self-nurture and self-calm.
Workshop attendees will learn;the theoretical underpinnings and rationale
of imagery-based CB interventions; how to apply and integrate imagery-based
interventions as part of a schema-based, cognitive processing model in
treating assault victims; how to apply the Socratic method in imagery
and schema modification; results of empirical investigations on the efficacy
of imagery-based CB interventions in the treatment of victims of assault
Smucker, M. R., & Dancu, C.V. (1999). Cognitive Behavioral Treatment
for Adult Survivors of Childhood Trauma: Imagery Rescripting and Reprocessing.
Northvale, NJ: Jason Aronson.
Smucker, M. R., Dancu, C., Foa, E.B., & Niederee, J. (1995). Imagery
Rescripting: A new treatment for survivors of childhood sexual abuse suffering
from posttraumatic stress. Journal of Cognitive Psychotherapy: An International
Quarterly, 9(1), 3-17.
Smucker, M. R., & Niederee, J. (1995). Treating incest-related PTSD
and pathogenic schemas through imaginal exposure and rescripting. Cognitive
and Behavioral Practice, 2, 63-93.
Phobia - Understanding and Treatment
Ronald M. Rapee, Macquarie University, Sydney, Australia.
The aim of this workshop will be to describe the nature and treatment
of social fears and anxieties in adults. Recent publicity has focused
extensively on biomedical and pharmacological treatments for social anxiety
disorder. In contrast, this workshop will cover the strongest evidence-based
psychological treatment programs for this problem. Research data show
that psychological treatments are at least as effective as pharmacological
treatments for social phobia in the short term and are far more effective
for long-term management of the problem.
The workshop will begin at an introductory level, but will move onto more
advanced applications. We will begin with coverage of the recognition
of social fears and diagnosis of social phobia and related disorders in
both children and adults. The workshop will then move on to consideration
of assessment issues and will provide an overview of current views of
aetiology and maintenance of the problem. The majority of the workshop
will concentrate on coverage of psychological treatment strategies. Basic
components such as cognitive restructuring and exposure will be covered.
More recent techniques such as attention training, the role of safety
cues, and detailed feedback will also be addressed. Given time, difficulties
in application such as comorbidity and other complications will be discussed.
Where possible, the workshop will make use of case presentations, video,
and role play.
Attendees will learn: how to recognise and diagnose social phobia in adults;
how to assess social fears; a better understanding of the possible causes
and maintaining factors in social fears; strategies in the management
Rapee, R.M. (1998). Overcoming shyness and social phobia: A step by step
guide. New Jersey: Aronson.
Rapee, R.M. & Sanderson, W.C. (1998). Social phobia: Clinical application
of empirically validated treatments. New Jersey: Aronson.
Rapee, R.M., & Heimberg, R.G. (1997). A cognitive-behavioral model
of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756.
Intervention for Comorbid Substance Abuse and Psychosis
David J. Kavanagh, University of Queensland, Australia
Comorbidity of substance abuse and psychosis is both very common and problematic,
especially in young men. Very little is known about effective treatment
methods, beyond the need to integrate treatment of both disorders. In
the general community, brief interventions have demonstrated remarkable
effectiveness, especially for alcohol abuse. Our research team has developed
a brief intervention strategy (Start Over and Survive-SOS), which focuses
on motivation enhancement and collaborative planning, and appears particularly
suited to early episodes of psychosis. SOS is typically conducted in 3
hours of initial inpatient or community-based contact with the participant
plus one family session. The treatment is grounded in routine assessment
of all patients with psychosis using a brief assessment measure (the DrugCheck),
which has high sensitivity and specificity in relation to interview assessment
on the CIDI.
Phase 1 of SOS focuses on development of rapport and engagement in discussions
with the therapist, using sessions of 2-5 minutes and continuing until
a positive relationship is developed and thought disorder and distress
are sufficiently resolved for further assessment and intervention to occur.
Phase 2 employs motivational enhancement regarding substance use, which
continues until there is commitment to change the manner or amount of
use, or the 3 hours is completed. Phase 3 discusses planning for the control
attempt, including identification of high-risk situations, application
of problem solving, and introduces training of one set of relevant skills
(either drug refusal or dealing with dysphoria, according to the individual's
greater short-term need). Phase 4 encourages continuation of the attempt
in fortnightly contacts conducted by telephone or in routine community
sessions. We have examined previous versions of the brief intervention
in two case series, and have shown SOS to be significantly more effective
than standard care in a small preliminary outcome trial. SOS is currently
being tested against a contact control in a larger study, preliminary
results of which will be presented.
After a brief outline of the relevant literature, this workshop reviews
the manualised treatment, providing demonstrations of its segments and
substantial opportunities for skills practice. Challenges in the application
of the procedure are discussed, including problems with engagement and
with difficult environmental settings. Approaches to people with more
severe substance-related problems, skills deficits or cognitive disorder
Kavanagh, D. J., Greenaway, L., Jenner, L., Saunders, J. B., White, A.,
Sorban, J., Hamilton, G., and members of the Dual Diagnosis Consortium
(2000). Contrasting views and experiences of health professionals on the
management of comorbid substance abuse and mental disorders. Australian
and New Zealand Journal of Psychiatry 34, 279-289.
Kavanagh, D. J., Young, R., Boyce, L., Clair, A., Sitharthan, T., Clark,
D., & Thompson, K. (1998). Substance Treatment Options in Psychosis
(STOP): A New Intervention for Dual Diagnosis. Journal of Mental Health,
Kavanagh, D. J., White, A., Young, R., Saunders, J. B., Shockley, N.,
Wallis, G. (in submission). SOS-A brief intervention for substance abuse
in early psychosis. In: H. Graham, K. Mueser, M. Birchwood, & A Copello
(eds.) (2001). Substance misuse in psychosis: Approaches to treatment
and service delivery. Chichester, UK: John Wiley & Sons.
and Treating Worry
Mark H. Freeston, Newcastle Centre for Behavioural
and Cognitive Therapies, Newcastle-on-Tyne
Worry is a normal part of everyday life for many people in response to
particular events. For others, worry becomes a generalized response to
day-to-day living and is perceived as uncontrollable. Worry then becomes
distressing, time-consuming, and ineffective in dealing with minor and
major life events. Such excessive worry is a common feature of many emotional
disorders, especially the anxiety disorders, and is the central defining
feature of Generalised Anxiety Disorder. Worry the may be conceptualized
as complex chains of thoughts and images about possible events, elaboration
of the possible consequences of the thoughts and the situations they refer
to, attempts at problem solving, and attempts to control the chains of
cognitive events and the associated distress. Based on developing an alternative
understanding of worry during therapy, people can learn to break these
This workshop will provide professionals with:
o A framework for identifying the key components in chains of worry.
o The ability to recognize the often contradictory assumptions that maintain
the ineffective processing.
o Criteria for distinguishing between thoughts about situations that require
instrumental action and those where no instrumental action is possible.
o A structured approach to reduce ineffective thought control strategies
that maintain worry.
o Troubleshooting and using this approach in other disorders where worry
may make up of the
Applications of Mindfulness Training
John Teasdale MRC Cognition and Brain Sciences Unit,
The aims of this workshop are 1) to communicate an understanding of mindfulness,
both experientially and conceptually; 2) to illustrate how mindfulness
is trained through experiential exercises and video clips of clinical
sessions; 3) to indicate the clinical relevance of mindfulness training
; 4) to describe and illustrate a specific clinical application of mindfulness
training to the prevention of relapse in recurrent major depression: its
rationale, practical content, and evidence of effectiveness. Training
modalities will include experiential exercises, video clips, didactic
presentation, and interactive communication within each of these modalities.
Kabat-Zinn, J. (1990) Full Catastrophe Living: The Program of the Stress
Reduction Clinic at the University of Massachusetts Medical Center. New
York: Delta (Piatkus: London, 1996)
Teasdale, J.D. et al. (2000). Prevention of relapse/recurrence in major
depression by mindfulness-based cognitive therapy. Journal of Consulting
and Clinical Psychology, 68, 615 - 623.
Supervision Skills: A Cognitive Perspective
Gillian Butler, Oxford Cognitive Therapy Centre. The
Warneford Hospital, Oxford
This workshop is intended to fill an important gap. Supervision is an
essential element of professional practice, but few people have had the
opportunity to learn about how to provide it, or about the various ways
in which they could work to facilitate both learning and professional
development. This workshop will use the cognitive-behavioural model as
a starting point for identifying good and bad practices in supervision.
It is intended to help people to reflect upon their strengths and weaknesses
as supervisors, and to help them consider how best to develop the next
level of skill appropriate to their working context. It will also provide
an opportunity to think about how to recognise, define and deal with some
of the problems and difficulties that arise during supervision. The emphasis
will be practical; and. participants will be expected to take part in
discussion and exercises including role-play, so as to think about how
to apply what they learn to their own practice.
The workshop is intended for those who already have experience of supervising
as well as for experienced clinicians who wish to start supervising. It
will probably be of most relevance to those who are familiar with and
use a cognitive approach to treatment, but others may also find it useful.
Cognitive Behavioural Therapy
Satwant Singh & Rob Willson, The North London
Since Cognitive Therapy (CT) was proposed for the treatment of depression
in the late 70's (Beck et al, 1979) which proved to be successful in terms
of efficacy from a time limited therapy. Cognitive Behavioural Therapy
(CBT) has now expanded and developed to treat different emotional problems
eg anxiety disorders and more recently innovative work in bi polar disorders
and psychosis. As a result of CT's efficacy it has become a popular type
of therapy for those disorders. Yet accessibility for patients needing
CBT is limited. In this climate of economical constraints in health care
provisions and limitations in private health insurance it is increasingly
difficult for patients to receive therapy. One approach that could deal
with these difficulties is the provision of group CBT, as it is economical,
able to treat a larger number of patients within a limited number of sessions
and utilize the skills and knowledge of the therapist effectively. In
has recently attracted attention but there is still a lack of practitioners
who have the necessary skills to provide group therapy.
This workshop is designed to address the needs of practitioners who have
an interest in providing group CBT and developing skills in this area.
It is designed for practitioners who are interested in, and wish to develop
an understanding of the principle involved in group cognitive behavioural
Areas to be covered in the workshop: Assessment for Group therapy; Group
membership and patient mix; Group ethics; Structure and format; Issues
of timing; Difficulties and trouble shooting; Type of groups for CBT (core,
skills and specialized)
Dryden, W (1998) Teaching self acceptance a brief small group approach.
Free, M.L., Sanders, M.R. & Oei, T.P.S. (1991) Treatment Outcome for
a Group Cognitive Therapy Programme for Depression. International Journal
of Group Psychotherapies, 41(4), 533-547.
Freeman, A., Schrodt, G.A., Gilson, M. & Ludgate, J.W. (1993) Group
Cognitive Therapy with Inpatients. In Wright, J.H., Thase, M.E., Beck,.A.
& Ludgate, J.W. (editors) Cognitive Therapy with Inpatients, (pp 121-154),
Guildford Press, London.
Scott M.J. & Stradling, S.G. (1990) Group Cognitive Therapy for Depression
Produces Clinically Significant Reliable Change in Community-based Settings.
Behavioural Psychotherapy, 18, 1-19.
Simon, K.M. (1994) A Rapid Stabilization Cognitive Group Therapy Programme
for Psychiatric Inpatients. Clinical Psychology and Psychotherapy, 1(5),
Steketee, G., Oford, R., Wincze, J, Greene,K.A.I. & Douglas, H. (2000)
Group and Individual Treatment of Compulsive Hoarding: A Pilot Study.
Behavioural and Cognitive Psychotherapy,28, 259-268.
Behaviour Therapy For Chronic Medical Problems.
Craig A. White, University of Glasgow
This workshop is aimed at an intermediate level for practitioners with
a basic knowledge and competence in the application of cognitive behavioural
therapies for anxiety and depressive disorders. Chronic medical problems
are often associated with clinically significant psychological problems
and involve a number of cognitive and behavioural challenges. There is
considerable evidence to support the efficacy of CBT for common chronic
medical problems such as chronic pain and the psychological problems associated
with cancer. In this workshop, participants will be encouraged to consider
their work as therapists with people experiencing chronic or intractable
medical conditions and the clinical problems experienced by this patient
group. Although cognitive behaviour therapists often treat patients with
psychological disorders such as anxiety or depression, it can be difficult
to adapt standard CBT protocols for patients with comorbid physical health
problems. Participants will have opportunities to consider how elements
from their current practice might apply to this work and to learn about
the application of CBT to specific medical problems. The issues which
need to be taken into account to tailor CBT to the specific needs of patients
with disorders such as cancer, chronic pain, cardiac disorders or diabetes
will be addressed. The focus of the workshop will be on practical experience
and examples to reinforce and develop key therapist competencies in the
areas of assessment, formulation and treatment planning.
Following attendance at this workshop, participants will: Understand the
ways in which cognitive behaviour therapy is particularly applicable to
working with people with longstanding medical problems; Have practised
a cognitive behavioural assessment which takes account of the psychological
dimensions associated with chronic medical problems such as chronic pain,
cancer or diabetes; Have constructed examples of problem and case level
formulations (using case examples from the clinical work of participants);
Understand how cognitive and behavioural interventions can be applied
to the psychological problems associated with longstanding medical problems.
Lacroix, J.M., Martin, B., Avendaro, M., and Goldstein, R. (1991). 'Symptom
Schemata in Chronic Respiratory Patients', Health Psychology, 10(4),
Keefe, F., Jacobs, M. and Edwards, C. (1997). 'Persistent Pain: Cognitive
Behavioral Approaches to Assessment and Treatment'. Seminars in Anesthesia,
White, C.A. (2001). Cognitive Behaviour Therapy for Chronic Medical Problems.
A Guide to Assessment and Treatment in Practice. Wiley Series in Clinical
Psychology. Chichester: John Wiley & Sons.
Douglas Turkington & Jeremy Pelton. University
A CBT for psychotic disorders which is schema focussed and formulation
driven is now emerging. This workshop will describe in detail the phases
of this approach i.e. how to engage the psychotic patient, develop viable
explanations and reduce stigma, collaboratively construct a case formulation
and then move on to control symptoms and empower improved coping. These
fundamentals of CBT for psychosis are then given a more durable effect
through an understanding of how to effect changes in attitudes towards
medication and changes in schemas which drive and maintain the psychotic
symptoms. Relapse prevention strategies complete the process of therapy.
Pitfalls and blocks in therapy are clearly described and strategies for
overcoming them explained. These strategies are applied in a different
way in the four subgroups of schizophrenia, delusional disorder and in
schizoaffective psychosis and psychotic depression. The efficacy of the
CBT described is markedly enhanced when the subgroup is identified e.g.
traumatic psychosis as opposed to drug induced psychosis.
Detailed case examples will describe a blow by blow account of the CBT
sessions in each case backed up by brief video clips. Participants in
this workshop will be expected to have a good basic CBT knowledge and
wide experience of interacting with psychotic patients. Participants will
be asked for their opinions on the application of techniques in relation
to the case formulation and role plays will be used to illustrate key
points. By the end of the day participants will feel greatly encouraged
in using CBT in a variety of different psychoses and will be clear about
risk management in relation to this. They will be excited by the realisation
that the symptoms of psychotic patients are not incomprehensible but entirely
understandable in relation to the case formulation and schema profile.
The workshop aims to clearly describe due process of CBT with different
psychoses, to make psychotic symptoms understandable in relation to the
case formulation and schema profile, to describe a number of techniques
at different levels e.g. peripheral questionning of a delusion to working
with the schema linked to the delusion, to clearly understand risk assesment
in relation to CBT of psychoses.
Turkington, D. and Siddle, R. Improving understanding and coping in people
with schizophrenia by changing attitudes. Psychiatric Rehabilitation Skills
2000: 4(2): 300-320.
Sensky, T., Turkington, D., Kingdon, D. et al A randomised, controlled
trial of cognitive-behaviour therapy for persistent symptoms in schizophrenia
resistant to medication. Archives of General Psychiatry 2000:57; 165-172.
Intervention in Psychosis
Chris Jackson and Paul Patterson, Early Intervention
Service, North Birmingham Mental Health NHS Trust
The end of the beginning of the individual's journey through psychotic
illness occurs during the period of time following a first episode which
is now known to be critical and formative (Birchwood, Todd and Jackson,
1998). The individual and family's psychological adjustment and adaptation
during the early years of psychosis appears to be important but remains
poorly understood (Jackson and Birchwood, 1996) and has attracted relatively
little interest from clinicians and researchers.
Psychological adaptation and adjustment to the first episode may have
implications beyond the active phase of psychosis. For instance, with
medical and psychosocial treatments, which can be viewed as a form of
coping behaviour in its own right (Leventhal, Meyer & Nerenz, 1980)
may have a powerful influence upon outcome (Bebbington, 1995). Such adherence
and engagement are likely to be influenced by a wide variety of clinical
and psychological factors (Buchanan, 1996) tied up with the adjustment
Although we understand little about early adaptation to psychosis, we
do know that it can be a very difficult period for both individual and
family (Patterson, Birchwood and Cochrane, 2000), trauma (McGorry et al,
1991), and period of recovery. Social withdrawal and isolation may begin
and significantly worsen during the first two years as social networks
shrink (Erickson, Beiser & Iacono, 1999) and are not replaced (Jackson
& Edwards, 1992). Drug and alcohol abuse may also have their origins
in this early phase (Kovaszany et al, 1997). In this workshop we will
focus on the process of adjustment in both individual and family. We will
particularly look at how CBT may make a positive contribution to such
an adjustment process and thereby reduce problems of comorbidity in those
The aim of the workshop is to look at how cognitive and behavioural therapies
may contribute to the adjustment process for families and individuals
following a first episode of psychosis. The workshop is suitable for anyone
working psychologically with young people and their families recovering
from a first episode of psychosis.
Birchwood,M., Fowler,D. and Jackson,C (2000) Early Intervention in Psychosis,
Patterson,P., Birchwood,M. and Cochrane,R. (2000) Preventing the entrenchment
of high EE in first episode psychosis: early developmental atgtachment
pathways. Australian and New Zealand Journal of Psychiatry, 34 (suppl)
From Research On Expressed Emotion: Building Positive Relationships
Estelle Moore, Broadmoor Hospital, Institute of Psychiatry,
Research using the expressed emotion paradigm has demonstrated substantial
consistency across cultures and over time, endorsing the social environment
as important in determining the course and outcome of problems in mental
health (Kavanagh, 1992). Relationships between family carers, staff working
in services and service users are pivotal to the success, or otherwise,
of interventions which aim to ameliorate distress (Kuipers & Moore,
1995). The aim of this workshop is to review the implications of recent
research on relationships (Moore et al, 2000), and to consider techniques
for encouraging the development and maintenance of environments which
support people with enduring mental health needs.
This workshop will review the literature on the implications of expressed
emotion research for psycho-social intervention in services with professional
and family carers; study recent observations about the nature of relationships
in services; explore methods of intervention to reduce the impact of 'negative'
interchanges linked with the anxiety that complex behavioural presentations
typically evoke for carers.
The workshop is particulaly suitable for practitioners working within
CBT framework with patients with long-term needs including psychosis
Kavanagh, D.J. (1992). Recent developments in expressed emotion and schizophrenia.
Br Journal of Psychiatry, 160: 601-620.
Kuipers, E. & Moore, E. (1995). Expressed emotion and staff-client
relationships: implications for the community care of the severely mentally
ill. International Journal of Mental Health, 24: 13-26.
Moore, E., Yates, M., Mallindine, C., Ryan, S., Jackson, S., Chinnon,
N., Kuipers, E. & Hammond, S. (2000). Expressed emotion in relationships
between staff and patients in forensic services: Changes in relationship
status at 12 month follow-up. Submitted for publication.
for Bipolar Disorder
Dominic Lam and Ed Watkins, Institute of Psychiatry,
Bipolar affective disorder is a serious illness with significant suicide
risk and high social cost. Treatment for manic depression in the past
three decades has been predominantly pharmacotherapy. Lithium carbonate
has been the most common and influential drug of choice. Yet more recently
questions have been rasied about the effectiveness of Lithium in normal
and clinical settings (Solomon et al;, 1995; Moncrieff 1995). Lithium
is ineffective for at least 20% to 40% of classical bipolar patients,
either due to inadequate response or side effects (Pren and Potter, 1990).
Other common prophylactic drugs, such as Carbamazepane and valproate generally
only show equivalent efficacy to Lithium (Salomon et al 1995)
Due to the above findings, the 1989 National Institute of Mental Health
Workshop on Treatment of Bipolar Disorder (Pren and Potter 1990) urged
that more research should be directed both to alternative drug strategies
and to the development of psychotherapies specific to this disorder. We
have conducted a randomised controlled pilot study with encouraging results
(Lam, Bright, Hayward et al, in press). Currently we are recruiting 100
bipolar patients for an RCT to replicate our finding of the pilot study.
The workshop is based on the book of the same title (Lam, Jonbes, Hayward
abd Bright, 1999). It targets qualified mental health professionals with
a cognitive behavioural background who are interested to work with bipolar
patients. The aim of the workshop is to equip participants with the necessary
knowlege and techniques to conduct CBT with bipolar patients. The aims
of the workshop are: to be familiar with the diagniosis and classify bipolar
illness into subtypes; to be able to list the outcome and course of the
illness and the effectiveness of prophylacticc medication; to be able
to define and elicit common prodromes; to list and describe the vulnerability
issues; to be able to describe the common CBT techniques for bipolar illness
Lam DH, Bright J, Hayward P, Schuck N, Chisholm, D and Sham P (in press).
Cognitive therapy for bipolar illness- a pilot study of relapse prevention.
Cognitive Therapy and Research
Lam DH, Jopnes, S.H., Haywood, S & Bright, JA (1999) Cognitive Theapy
for Bipolar Disordr: A Therapist's Guide to concepts, methods and practices.
Wiley & Son, London
Lam DH and Wong G (1997) Prodromes, coping strategies, insight and social
functioning in bipolar affective disorders. Psychological medicine, 27,
1091 - 1100
Depression : Practical CBT Skills to Use with Patients in Less than Fifteen
Chris Williams, University of Glasgow.
The workshop is for those who want to gain a basic understanding of how
to use CBT assessment and management skills in everyday practice. This
includes both primary and secondary health care practitioners such as
nurses, CPN's, OT's, Psychiatrists, GP's, Psychologists and social workers.
The content will also be of use to those who are interested in offering
training in CBT skills that can be used in non-CBT specialist clinical
The training will cover: An introduction to the Cognitive Behaviour Therapy
(CBT) approach to management of depression; Using the Five Areas assessment
model of depression with patients; An overview of the management of depression
using the Overcoming Depression Course structure to determine helpful
psychological interventions with the patient. Developing skills in using
a Thought Worksheet to identify and challenge unhelpful and extreme depressive
thinking styles and practice this approach using role play; Developing
skills in enabling the patient identify their Vicious circle of reduced
activity and unhelpful behaviours and bring about change by using action
plans; Developing skills in Practical Problem solving, increasing confidence
to use these skills with patients; A review of ways to effectively use
structured self-help materials.
The workshop uses interactive teaching methods, role-play and case histories
to facilitate skills development.
Throughout the Pre-Conference Workshops and Conference
will be an exhibition of books and journals organised by WISEPRESS