Workshop presenters and topics.

Wednesday 20th June 2001

1. Cognitive Therapy of Resistance
1. Robert Leahy (University Medical College & American Institute for Cognitive Therapy, New York, USA)

2. Conceptualization and Treatment of Anxiety Disorders in Youth
Philip Kendall (Temple University, Philadelphia, USA )

3. Helping the Difficult Patient
David Burns (Stanford University School of Medicine, Stanford, USA)

4. Anger Assessment and Treatment
Ray Novaco (University of California, Irvine, USA)

5. Using Imagery to Enhance the Effectiveness of Exposure and Cognitive
Restructuring in Treating Trauma Victims of Physical Assault and Abuse
Mervin Smucker (Medical College of Wisconsin, USA)

6. Social Phobia: Understanding and Treatment
Ronald M. Rapee (Macquarie University, Sydney, Australia )

7. Brief Intervention for Comorbid Substance Abuse and Psychosis
David Kavanagh (University of Queensland, Australia)

8. Understanding And Treating Worry
Mark Freeston (University of Newcastle-upon-Tyne) 

9. Clinical Applications of Mindfulness Training
John Teasdale (MRC Cambridge)

10. Supervision Moving beyond the mere Transmission of CBT Techniques
***Claudia Herbert (Oxford) This is now a mini-workshop.***

11. Improving Supervision Skills: A Cognitive Perspective
Gillian Butler (University of Oxford)

12. Group Cognitive Behavioural Therapy
Satwant Singh & Rob Willson (Priory Hospital Grovelands)

13. Steve Baldwin (University of Teesside)
***This workshop is cancelled due to the tragic death of Professor Steve Baldwin. A free round-table discussion will be held in his honour on Friday morning.***

14. Cognitive Behaviour Therapy For Chronic Medical Problems.
Craig White (University of Glasgow)

15. CBT and Psychoses
Doug Turkington (University of Newcastle-upon-Tyne) 

16. Early Intervention in Psychosis
Chris Jackson (University of Birmingham)

17. Learning From Research On Expressed Emotion: Building Positive Relationships
Estelle Moore (Institute of Psychiatry)

18. CBT for Bipolar Disorder
Dominic Lam and Ed Watkins (Institute of Psychiatry)

19. Rational Emotive Behaviour Therapy For Depression
***This workshop will no longer take place.***

20. Overcoming Depression: Practical CBT skills to use with patients in less than fifteen minutes.
Chris Williams (University of Glasgow)

21. Using Behavioural Methods with Families of Conduct Problem Children
***This workshop will no longer take place.***


 

1. Cognitive Therapy of Resistance

Robert L. Leahy, American Institute for Cognitive Therapy,
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 counter-transference.

Recommended readings:
Robert L. Leahy (2001) Cognitive Therapy of Resistance. New York: Guilford.Leahy, R.L. Decision-making and Mania. Journal of cognitive psychotherapy, 1999 13, 1-23.
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.


2. Conceptualization 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.

Recommended reading:
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,
62, 100-110.
Kendall, P. C. (2000). Childhood disorders. London: Psychology Press.


3. Helping the Difficult Patient: Transforming Therapeutic Failure into Success

David D. Burns, Stanford University School of Medicine, USA

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 volunteers.

Recommended Reading
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), 441-449.
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.


4. Anger Assessment and Treatment

Raymond W. Novaco, University of California, Irvine, USA

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.

Recommended reading
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 Press.
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


5. Using 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 Therapy Institute

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 and abuse.

Recommended Readings:
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.


6. Social 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 of
social phobia.

Recommended Reading
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.


7. Brief 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 are described.

Recommended Reading
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, 7, 135-143.
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.


8. Understanding 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 self-perpetuating chains.

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
clinical presentation.


9. Clinical Applications of Mindfulness Training

John Teasdale MRC Cognition and Brain Sciences Unit, Cambridge

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.

Recommended Reading
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.


11. Improving 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.


12. Group Cognitive Behavioural Therapy

Satwant Singh & Rob Willson, The North London Priory Hospital

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 therapy
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)

Recommended Reading
Dryden, W (1998) Teaching self acceptance a brief small group approach. Wiley
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), 286-291.
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.


14. Cognitive 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.

Recommended Reading
Lacroix, J.M., Martin, B., Avendaro, M., and Goldstein, R. (1991). 'Symptom Schemata in Chronic Respiratory Patients', Health Psychology, 10(4),
268-273.
Keefe, F., Jacobs, M. and Edwards, C. (1997). 'Persistent Pain: Cognitive Behavioral Approaches to Assessment and Treatment'. Seminars in Anesthesia, 16(2), 117-126.
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.


15. CBT and Psychoses

Douglas Turkington & Jeremy Pelton. University of Newcastle-upon-Tyne

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.

Recommended Reading
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.


16. Early 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 process.

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 affected.

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.

Recommended Reading
Birchwood,M., Fowler,D. and Jackson,C (2000) Early Intervention in Psychosis, Wiley.
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) 5191-5197.


17. Learning From Research On Expressed Emotion: Building Positive Relationships

Estelle Moore, Broadmoor Hospital, Institute of Psychiatry, London

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

Recommended reading
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.


18. CBT for Bipolar Disorder

Dominic Lam and Ed Watkins, Institute of Psychiatry, London

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

Recommended Reading
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


20. Overcoming Depression : Practical CBT Skills to Use with Patients in Less than Fifteen Minutes.

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 settings.

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 there
will be an exhibition of books and journals organised by WISEPRESS