Workshop 2

Acceptance and Commitment Therapy: Experiential Awareness and Valued Life Change

Robyn D. Walser, TL Consultations Services, National Center for PTSD, Palo Alto Health Care System, USA

Acceptance and Commitment Therapy (ACT) is a new model of behavioural treatment that emphasises acceptance of internal experience while maintaining a focus on positive behaviour change. This approach is designed to address maladaptive avoidance of internal experiences associated with many problems in functioning while also focusing on making and keeping commitments. ACT uses a variety of verbal, experiential and homework techniques to help clients make experiential contact with previously avoided private events (thoughts, feelings, sensations), without excessive verbal involvement and control - and to help clients make powerful life enhancing choices. This workshop will explore the theory underlying ACT while also introducing the approach including an overview of the main stages of the therapy. In addition, the presentation will include experiential exercises as demonstration of the kind of work that is done in a therapy session

Key Learning Objectives

• Participants will be able to describe the psychopathological impact of experiential avoidance.
• Participants will be able to describe how human language participates in suffering and our relationship with private internal experiences.
• Participants will be able to describe the major steps in ACT.
• Participants will be able to describe how use values work is used to support behaviour change.

Robyn D. Walser, Ph.D, is a  psychologist working at the National Center for PTSD at the Veterans Affairs Palo Alto Health Care System and she has a private practice that includes consultation and workshop services plus psychotherapy (TLConsultation Services). She received her degree in Clinical Psychology from the University of Nevada-Reno and during her graduate studies developed expertise in, traumatic stress, substance abuse and Acceptance and Commitment Therapy (ACT). She has been doing ACT workshop trainings both nationally and internationally since 1998; training in multiple formats and for multiple client problems. She continues her research aspirations and is currently involved in several projects investigating use of mindfulness and ACT in PTSD populations.

Key References
Eifert, G. H., Forsyth, J. P. & Hayes, (2005). Acceptance & commitment therapy for anxiety disorders: A practitioner's treatment guide to using mindfulness, acceptance, and values-based behaviour change strategies. Oakland, CA: New Harbinger.

Hayes, S. C. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. Oakland, CA: New Harbinger.

Hayes, S. C. & Strosahl, K. (2004). A practical guided to acceptance and commitment therapy. New York: Springer.

Hayes, S. C., Strosahl, K. & Wilson, K. G. (1999).  Acceptance and Commitment Therapy: An experiential approach to behaviour change.  New York: Guilford Press. 

Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2001) (Eds.), Relational Frame Theory: A Post-Skinnerian account of human language and cognition. New York: Plenum Press.

Walser, R. D. & Westrup, D. (in press). Acceptance and commitment therapy for PTSD: A practitioner's guide to using mindfulness and acceptance strategies. Oakland, CA: New Harbinger. [Currently available for order on Amazon.com]

Workshop 3

Doing Cognitive Behaviour Therapy with Borderline and Antisocial Personality Disorders

Kate Davidson, University of Glasgow and NHS Greater Glasgow and Clyde, Melanie Sharp and Judith Halford NHS Greater Glasgow and Clyde

CBT significantly reduces the number of suicidal acts, symptoms and negative core beliefs in individuals with borderline personality disorder (BOSCOT: Davidson et al, 2006).  Kate Davidson's research group are currently carrying out a further randomised controlled trial using CBT with individuals with antisocial personality disorder who are violent.

Key Learning Objectives
Workshop participants will learn the following:  Adaptations of the CBT model to personality disorders, formulating a case within the model and how to share this with patients, how to work on underdeveloped behaviours and develop new adaptive beliefs.

Professor Kate Davidson is a clinical psychologist and Director of the Glasgow Institute of Psychosocial Interventions.  She has worked with individuals with personality disorder since 1992, developing CBT for antisocial and borderline personality disorders and carried out a series of research studies including randomised controlled trials in NHS settings to assess the effectiveness of CBT in these groups of patients. 

Key References
Davidson K.M. (2007) Cognitive therapy for personality disorders: a guide for clinicians.  Second Edition.  Routledge: Hove.

Davidson K.M., Tyrer P., Gumley A., Tata P., Norrie J., Palmer S., Millar H., Drummond L., Seivewright H., Murray H., Macaulay F. (2006)  Rationale, description, and sample characteristics of a randomised controlled trial of cognitive therapy for borderline personality disorder: the BOSCOT study.  Journal of Personality Disorders, 20, 431-449.

Davidson K., Norrie J., Tyrer P., Gumley A., Tata P., Murray H., Palmer S.  (2006) The effectiveness of cognitive behaviour therapy for borderline personality disorder: results from the BOSCOT trial.  Journal of Personality Disorders, 20, 450-465.

Workshop 5

Cognitive-Behaviour Therapy for Depressive Rumination

Edward Watkins, Mood Disorders Centre, University of Exeter.

This workshop is aimed at an intermediate level of CBT experience.

Key Learning Objectives

1. To review the theory and research relevant to depressive rumination- definition, consequences and importance.
2. To review existing and novel approaches for treating rumination, including behavioural activation, functional analysis, modifying thought form-process.
3. To summarise a cognitive formulation for rumination.
4. To illustrate treatment approaches to depressive rumination via audio/video, experiential exercises, and role-play.
5. To provide attendees with some experiential practice at these techniques.
   

At the end of the workshop

1. Workshop attendees will be able to describe the nature and consequences of depressive rumination.
2. Workshop attendees will be able to formulate individual cases of rumination within a functional-contextual model and identify appropriate treatment interventions.
3. Workshop participants will have insight into CBT approaches for depressive rumination.

Dr Watkins has published on cognitive processing in depression, in particular, ruminative thinking and autobiographical memory. Dr Watkins is an Associate Professor in Clinical Psychology at the School of Psychology, University of Exeter. Previously he was the Research Fellow for Cognitive Clinical Psychology of Depression at the Institute of Psychiatry. Dr Watkins has received specialist training in cognitive therapy, and as well as being a supervisor on the MSc course for CBT at the Institute of Psychiatry, was a therapist on the recently completed randomised controlled trial of CBT for bipolar affective disorder. He currently holds a 3-year Wellcome Project Grant to investigate cognitive processes in depressive rumination and a MRC Experimental Medicine grant to investigate self-help interventions for depression.

Key References
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504-511.

Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569 - 582.

Watkins, E. R. & Baracaia, S. (2002) Rumination and Social Problem-Solving in Depression. Behaviour Research and Therapy, 40, 1179-1189.

Workshop 6

Cognitive-Behaviour Therapy for Psychosis: Engagement and Treatment Issues for Complex Clients

Gillian Haddock, University of Manchester

This workshop is designed for practitioners who have experience of working with people who have psychosis and will provide practical experience using video and case examples.

This workshop aims to equip therapists with skills which will enable them to work with individuals who are often considered highly challenging , and can place a high level of demand on services. The workshop will first cover the background to working with clients with complex cases, such as those with psychosis and co-existing substance use and problems with aggression and violence. Attendees will be provided with references and literature. Second, the workshop will describe treatment approaches that have been developed to enable therapists to engage complex psychotic clients in CBT. Strategies to aid engagement and work with substance use and violence will be described, particularly integrating motivational interviewing. Such strategies will be highlighted with reference to case material. Attendees will have the opportunity to watch this therapy being delivered and to take part in experiential work to enable them to gain experience in delivering the approaches.

Gillian Haddock is Professor of Clinical Psychology at the University of Manchester and Honorary Consultant Clinical Psychologist for Pennine Care NHS trust in the North West of England. She has been involved in developing and evaluating psychological treatments for psychosis for over 15 years and has recently been involved in developing treatments that can engage, and address the needs, of complex clients with psychosis.

Key references
Haddock, G., Barrowclough, C., Tarrier, N., Moring, J., et al (2003) Randomised controlled trial of cognitive-behaviour therapy and motivational intervention for schizophrenia and substance use: 18 month, carer and economic outcomes. British Journal of Psychiatry, 183, 418-426.

Haddock, G., Lowens, I., Brosnan, N., Barrowclough, C. and Novaco, R.W. (2004) Cognitive-behaviour therapy for inpatients with psychosis and anger problems within a low secure environment. Behavioural and Cognitive Psychotherapy, 32, 77-98.

Workshop 8

Cognitive Behaviour Therapy for Life-threatening Illness

Stirling Moorey, South London and Maudsley Foundation Trust

Potentially fatal illness threatens our sense of ourselves, our relationship with the world and our life plans. Cognitive conceptualisations can help us to understand how our reactions to possible death are shaped by our underlying beliefs and characteristic coping strategies. Developing a formulation can guide us in our choice of cognitive, behavioural and supportive techniques. The changing course of physical illness and the effects of fatigue and disability require a flexible approach in the application of CBT techniques. This workshop will demonstrate the power of the cognitive model as a tool for conceptualising and planning treatment, so that effective interventions can be selected, even if it is not possible to carry out a full course of therapy. People with adjustment difficulties may need assistance in processing the emotional impact of illness, so the therapist must acquire skills in combining emotional-supportive techniques and CBT interventions. The importance of emotional validation and the facilitation of emotional processing will be discussed. Therapists can also be daunted by the presence of apparently realistic negative thoughts in people facing death, and also be overwhelmed by the patients' own feelings of helplessness and hopelessness. Methods for working with “realistic” negative thoughts will be described and illustrated

Key Learning Objectives

1. Participants will be able to conceptualise cases of life threatening illness using the cognitive model of adjustment to physical illness.
2. Participants will be able to discuss the modifications to standard CBT method in life threatening illness, including facilitating emotional processing and working with realistic NAT's.
3. Participants will understand some of their own “countertransference” reactions to life-threatening illness.
   

Dr Moorey is Consultant Psychiatrist in CBT at the Maudsley Hospital. He has been actively involved with cognitive therapy since 1979 and was co-founder of the Institute of Psychiatry Cognitive Therapy Course. From 1986-1991 he was a CRC research psychiatrist at the Royal Marsden Hospital, and worked with Dr Steven Greer to develop a cognitive based treatment for patients with cancer. He has recently completed a randomised controlled trial of CBT with terminally ill patients applied by St Christopher's Hospice home care nurses.

Key References:
1. Moorey, S. & Greer, S. (2002).Cognitive Behaviour Therapy for People with Cancer. Oxford University Press.

2. Moorey S (1996) When bad things happen to rational people: cognitive therapy in adverse life situations. In Salkovskis P(ed.) Frontiers of Cognitive Therapy. New York: Guilford Press

Workshop 9

Working with Imagery in Cognitive Therapy: Across Diagnoses

Ann Hackmann, University Department of Psychiatry, Oxford, Institute of Psychiatry, London, and Oxford Cognitive Therapy Centre, Oxford and
Emily Holmes, Dorothy Hodgkins Research Fellow, University Department of Psychiatry, Oxford

Recently there has been an increasing interest in mental imagery in psychopathology, but clinicians remain somewhat uncertain about how to work with it in an organised manner in cognitive therapy. This workshop is designed to help clinicians to understand that there are various types of images, appraised in a variety of ways, triggering differing responses. Hence imagery can function in several ways to maintain psychological problems. We will present a first attempt at taxonomy, to help guide our thinking in treatment. Arising from this provisional taxonomy, and a set of general principles concerning formulation, we will discuss a set of interventions that can be used across a wide range of psychological disorders to mitigate the effects of intrusive imagery.

Key Learning Objectives
Participants should leave the workshop with a clearer picture of how to understand imagery from a clinical and theoretical perspective, how to formulate problems in which imagery plays a role, and how to intervene to assist emotional processing, and transform or remove various types of disturbing imagery including nightmares.

Ann Hackmann works with Anke Ehlers and David Clark on Wellcome funded research in the anxiety disorders. Emily Holmes is a Dorothy Hodgkins Research Fellow in the University Department of Psychiatry in Oxford. Both have a special interest in imagery. Ann's studies have been into the phenomenology of imagery and memory, whilst Emily has done novel experimental research as well as clinical studies. Together with James Bennett-Levy they are working on ways to make this field more accessible to clinicians, so that it becomes easier to work with imagery in therapy.

Key References
*Holmes, E. A. and Hackmann, A. (Eds.). (2004). Mental Imagery and Memory in Psychopathology. Special Issue of Memory.

*Hackmann, A. (2004). Compassionate Imagery in the Treatment of Early Memories in Axis I Anxiety Disorders. In: P. Gilbert (ed). Compassion: Conceptualisations, Research and Use in Psychotherapy. London, Brunner-Routledge.

*Day, S., Holmes, E.M. and Hackmann, A. (2004). Occurrence of imagery and its links to memory in agoraphobia. Special Issue of Memory (as above)

Workshop 10

When the Rule Book Isn’t Enough: CBT for Anxiety Disorders When Standard Methods Don't Seem to Work

Gillian Butler, Oxford Cognitive Therapy Centre

When working with anxious people in normal clinical practice many CBT therapists say that it is hard to get the results that they feel they should. This can be dispiriting, especially when expectations for CBT are high. The NICE guidelines may add to the pressure. This workshop will focus on the application of cognitive-behavioural methods to the treatment of anxious people whose problems appear not to fit one of the standard patterns. This may be because they have more than one kind of anxiety; they may be depressed as well as anxious, or they may have long-standing problems more characteristic of someone with a personality disorder.

Key Learning Objectives
The workshop is intended for people who are familiar with the basic methods of CBT and whose caseload includes people with complex types of anxiety who may not respond well to standard short-term methods of treatment. Examples of will be provided to illustrate how such problems can be understood and formulated, and how CBT can be used creatively and productively with such people.

Gillian Butler is a Fellow of the British Psychological Society and a founder member of the Academy of Cognitive Therapy. Her work, both for the NHS and for Oxford Cognitive Therapy Centre has varied greatly. Through 10 years of clinical research with the University of Oxford, she helped to develop and evaluate cognitive-behavioural treatments for social phobia and for generalised anxiety disorder. She has a special clinical interest in the use of CBT during recovery from traumatic experiences in childhood and runs training workshops on a wide variety of topics relevant to practitioners of CBT, in this country and overseas. She is particularly interested in making the products of research available to the general public, and has written Overcoming Social Anxiety and Shyness, which is now available as a workbook as well. She is also co-author of Manage Your Mind: The Mental Fitness Guide and of Psychology: A Very Short Introduction.

Key references:
Beck, A. T., Emery, G. & Greenberg, R. 1985. Anxiety Disorders and Phobias: A Cognitive Perspective. New York, Guilford.

Clark, D.M. 1999. Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37, S5-S27.

Harvey, A., Watkins, E., Mansell, W & Shafran, R. 2004. Cognitive Behavioural Processes across psychological disorders. Oxford University Press

Newman, M.G. & Borkovec, T.D. 2002. Cognitive behavioural therapy for worry and generalised anxiety disorder. In G. Simos (Ed.). Cognitive Behaviour Therapy, A Guide for the Practising Clinician. Sussex, Brunner, Routledge.

Wells, A. 2000. Emotional Disorders and Metacognition. London, Wiley.

Wells, A. 1997. Cognitive Therapy of Anxiety Disorders: A Practical Manual and Conceptual Guide. London, Wiley.

Westbrook & Kirk, 2005. The clinical effectiveness of cognitive behaviour therapy: outcome for a large sample of adults treated  in routine practice. Behaviour Research and Therapy, 43, 1243-1261.

Yiend, J. 2004. Cognition, Emotion and Psychopathology: Theoretical, Empirical and Clinical Directions. Cambridge University Press.

Workshop 11

Cognitive Therapy for Post Traumatic Stress Disorder

Nick Grey, Centre for Anxiety Disorders and Trauma

This workshop presents Ehlers & Clark's (2000) cognitive model for PTSD and the cognitive therapy that has been developed from this. The clear and direct links between the theory and the treatment will be presented. This treatment has been demonstrated to be among the most effective treatments worldwide for PTSD in both randomised controlled trials and dissemination studies.

Key Learning Objectives
This workshop emphasises those aspects of treatment that are innovative and synthesise previous best practice, including how best to apply exposure / reliving for PTSD. The variety of cognitive and emotional responses to trauma, including shame, guilt and anger, are addressed, as are the broader repertoire of cognitive techniques that are needed in these circumstances. The workshop will help participants recognise obstacles to successful treatment and use the theory to identify treatment.

Nick Grey is a Clinical Psychologist at the Centre for Anxiety Disorders and Trauma, South London & Maudsley NHS Trust, and Institute of Psychiatry. His current clinical work is providing outpatient cognitive therapy to people with a variety of anxiety disorders and PTSD, both within randomised controlled trials and in a more general NHS service. He has worked extensively with adults who have experienced traumatic events, including people who are seeking asylum and refugees. He is a co-author on the forthcoming treatment manual of CT for PTSD (Ehlers et al).

Key references:
Ehlers, A. & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research & Therapy, 38, 319-345.

Ehlers, A., Clark, D.M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research & Therapy, 43, 413-431.

Workshop 12

Cognitive-behavioural Therapy for Anorexia Nervosa

Glenn Waller, Vincent Square Clinic, Central and North West London  Mental Health Foundation NHS Trust and Institute of Psychiatry, London

Cognitive behaviour therapy (CBT) is well established as the treatment of choice for adults with bulimic disorders, but there is far less evidence that any psychotherapy is superior when working with anorexic cases. Despite evidence that we understand the cognitive-behavioural psychopathology of anorexia nervosa, issues of motivation and physiology make it hard to apply such treatments. This workshop will consider the core of CBT for working with low-weight eating-disordered patients (including ensuring patient safety), and the 'meta'-skills that are needed to make it possible to apply the core techniques. Case material will be used throughout, and participants are encouraged to bring case material for discussion. The aim is to ensure that clinicians feel more skilled in using CBT safely and effectively with anorexic patients.

Key Learning objectives
To develop CBT skills of assessment, formulation and treatment with low weight eating-disordered patients.
To implement psychoeducation, motivational work and CBT techniques.
To address the factors that make the implementation of routine CBT difficult.

Professor Glenn Waller is a Consultant Clinical Psychologist at the Eating Disorders Service within Central and North West London Mental Health Foundation NHS Trust. He is also a Visiting Professor at the Institute of Psychiatry, University of London.

Key references
Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V., & Russell, K. (2007). Cognitive-behavioural therapy for the eating disorders: A comprehensive treatment guide. Cambridge, UK: Cambridge University Press.

Mountford, V., & Waller, G. (2006). Using imagery in cognitive behavioural therapy for the eating disorders: Tackling the restrictive mode. International Journal of Eating Disorders, 39, 533-543.

Workshop 13

Everything and the Kitchen Sink: Cognitive Behaviour Therapy for Obsessive Compulsive Disorder

Adam Radomsky, Concordia University, Canada

Obsessive-compulsive disorder (OCD) is a heterogeneous disorder; common symptoms include washing and checking behaviour, as well as primary obsessions (i.e., repugnant, unwanted, intrusive thoughts images and impulses).  There has been a surge in recent research on each of these forms of OCD, with publications often based solidly in a variety of cognitive-behavioural models of specific forms of OCD.  Although these models differ to some extent in their explanation of obsessional and compulsive phenomena, they share a number of important features that are consistent with broad cognitive (and to a lesser extent, behavioural) principles. 

Key Learning Objectives
This workshop will begin with a review of the theoretical and empirical work conducted on the psychopathology and treatment of different manifestations of OCD.  The workshop will continue with practical instruction on the cognitive-behavioural assessment and treatment of a variety of forms of the disorder, with particular emphasis on the treatment of compulsive checking and primary obsessions.  The assessment and treatment of other forms of OCD (e.g., contamination-based OCD, symmetry, ordering and arranging compulsions, etc.) will also be discussed.  Attendees will learn about cognitive case formulation, the importance of ongoing assessment, and specific therapeutic interventions, all following from cognitive-behavioural models of OCD.  Attendees are encouraged to bring their own case descriptions for discussion

Dr. Radomsky is an Associate Professor of Psychology at Concordia University.  He joined Concordia in 2001 after completion of his Ph.D. in clinical psychology at the University of British Columbia and a fellowship at Harvard Medical School / Massachusetts General Hospital.  His research investigates cognitive, behavioural and emotional aspects of OCD and a number of other anxiety disorders.  He has received several national and international awards for his work including the Canadian Psychological Association's President's New Researcher Award (2007), being named a Beck Institute Scholar (2005-06) and receiving a Canadian Institutes of Health Research (CIHR) New Investigator Award (2004-09).  Dr. Radomsky has published a number of peer-reviewed articles and book chapters related to cognition, behaviour and the anxiety disorders. His research is funded by the Canadian Institutes of Health Research and the National Sciences and Engineering Research Council of Canada.

Key references
Clark, D.A. (2004). Cognitive-behavioral therapy for OCD.  NY: Guilford.
Antony, M.M., Purdon, C., & Summerfeldt, L.J., (2007).  Psychological treatment of obsessive-compulsive disorders: Fundamentals and beyond. Washington, DC: APA.

Workshop 14

Training Skills for Trainers

Freda MacManus, Oxford Cognitive Therapy Centre

The current drive to make evidence-based psychological therapies accessible to as many patients as possible means that experienced CBT therapists are under pressure to disseminate CBT skills, often before they have developed confidence in their skill as a trainer. Historically CBT training has been done in the “see one, do one, train one” model. However, training others in complex skills such as CBT presents challenges, even for highly skilled and experienced clinicians. This workshop focuses on equipping participants with the training skills to most effectively disseminate CBT.

Key Learning Objectives
The workshop will be highly interactive and practical. It will integrate ideas from adult education, learning theory and management development in order to enable participants to learn how to:
•  Formulate clear, learner-centred objectives
•  Identify how the theory and practice of CBT inform training and supervision, creating a learning culture which reflects the therapy itself
•  Plan training to take account not only of what they wish to achieve but also of the context and learning process
•  Design and structure training sessions so as to maximise learning
•  Widen their repertoire of training methods

Participants will have the opportunity to apply what they learn to a training project of their own, to receive feedback on their work, and to experience a variety of learning methods for themselves. The overall aim of the workshop is to increase participants' skill and confidence as CBT trainers.

Dr Freda McManus is the Director of the University of Oxford's Post-graduate (Masters level) Diploma in Cognitive Therapy. She also undertakes clinical work for OCTC and provides supervision and workshops on cognitive therapy skills, and training in cognitive therapy.  Previously she worked as a Research Cognitive Therapist on treatment trials with Professors David Clark and Anke Ehlers, devising and evaluating cognitive therapy protocols for anxiety disorders. This work was carried out at the University of Oxford's Department of Psychiatry and also at the Centre for Anxiety Disorders and Trauma, at the Institute of Psychiatry, Kings College, London. Dr. McManus has published a number of journal articles and book chapters related to cognitive-behavioural treatments and the dissemination of those treatments.

Key references:
Freiheit, S.R. & Overholser, J.C. (1997) Training issues in cognitive-behavioral psychotherapy. Journal of Behaviour Therapy & Experimental Psychiatry, 28, 79-86

Mannix, K.A., Blackburn, I.M., Garland, A., Gracie, J., Morrey, S., Reid,B., Standart, S. & Scott, J. (2006) Effectiveness of brief training in cognitive behaviour therapy techniques for palliative care practitioners.Palliative Medicine, 20, 579-584

Milne, D.L., Baker, C., Blackburn, I.M., James, I. & Reichelt, K. (1999) Effectiveness of cognitive therapy training. Journal of Behavior Therapy & Experimental Psychiatry, 30, 81-92

Padesky, C.A. (1996)  Developing cognitive therapist competency: Teaching and supervision models.  In P.Salkovskis (Ed.), Frontiers in cognitive therapy.  Guilford, New York

Sholomskas, D.E., Syracuse-Siewert, G., Rounsaville, B.J. et al. (2005) We don't train in vain: A dissemination trial for three strategies of training clinicians in cognitive behavioural therapy. Journal of Consulting & Clinical Psychology, 73, 106-115

Workshop 16

Cognitive Behavioural Analysis System of Psychotherapy (CBASP): A New Treatment for Chronic Depression?

John Swan and Rob Durham, Section of Psychiatry and Behavioural Sciences, University of Dundee

Significant numbers of people suffer from Chronic Depression in which clinically low mood and associated symptoms continue unabated for two or more years but which may become a lifelong problem without effective treatment. There is an urgent need to develop effective psychological and pharmacological treatments to meet the needs of this population. Patients with Chronic Depression present particular challenges to psychological therapists and the evidence base for standard CBT with this disorder is weak. However, a large multi-centre clinical trial has demonstrated that Cognitive Behavioural Analysis System of Psychotherapy (CBASP) can be an effective therapy for chronic depression and a group of us in Dundee have been studying this approach for several years now in collaboration w! ith the originator of CBASP, Professor Jim McCullough. In CBASP, patients learn how their cognitive and behavioural patterns produce and perpetuate interpersonal problems and how to alter maladaptive patterns of interpersonal behaviour. CBASP focuses primarily on problematic interpersonal situations in the everyday lives of people with chronic depression using a structured intervention called situational analysis. In addition, it places considerable emphasis on the therapeutic relationship as a vehicle for change using an methodology termed disciplined personal involvement. Our clinical experience to date suggests that CBASP can be a very effective approach to a very difficult to treat disorder.

Key Learning Objectives:      
To introduce participants to this new psychotherapy which is, to date, the only therapy specifically designed to meet the clinical needs of chronically depressed individuals. In this workshop we outline the therapy process and key mechanisms of change using examples to illustrate the techniques specific to CBASP. The theoretical model underpinning CBASP will be outlined. The evidence from a large clinical trial will be summarised.

Learning Objectives
To be introduced to and begin to understand the CBASP model.
To learn about and rehearse the key mechanisms and techniques of change in CBASP .
To reflect on the difficulties and problems associated with working with chronically depressed individuals.

John Swan is a Clinical Lecturer and Psychotherapist with the University of Dundee. He is Course Director of the Post Graduate Diploma in CBT and has been a CBT practitioner for 18 years. Clinical Work is with individuals with chronic affective disorders and OCD. Recently trained with and continues to receive supervision from Prof JP McCullough Jr, the originator of CBASP
Dr. Rob Durham is a Senior Lecturer in Clinical Psychology with University of Dundee. He teaches and administers two courses focussing on CBT and has published extensively in the psychological literature. His clinical work is with individuals with chronic affective disorders and OCD. Recently trained with Prof JP McCullough the originator of CBASP.

Key References:
Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, D. L., Gelenberg, A. J., Markowitz, J. C., Nemeroff, C. B., Russell, J. M., Thase, M. E., Trivedi, M. H. and Zajecka, J. (2000), A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342, 1462-70.

McCullough, J. P., Jr. (2000) Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP), Guilford, New York.

McCullough, J.P., Jr (2001) Skills Training Manual for Diagnosing and Treating Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy. The Guilford Press, New York and London

Workshop 17  

Anger Assessment and Treatment

Raymond Novaco, University of California, Irvine, USA

Anger dysregulation 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. Anger is a common precursor of aggressive behaviour, and it can be unsettling for mental health professionals as a treatment focus. Clients with recurrent anger problems are often not eager to engage in treatment. As treatment should be grounded in assessment of anger control deficits, various psychometric, staff-rated, and interview methods will be presented. CBT anger treatment will be overviewed, highlighting work with forensic patients. The workshop will address getting treatment engagement with challenging clients, cognitive restructuring and arousal reduction techniques, the stress inoculation provocation hierarchy procedure, and the use of role play to foster behavioural coping skills. Both individual-based and group-based treatment will be illustrated.

Anger assessment is not straightforward, because of reactivity to the testing situation and the multi-dimensionality of anger. Targeting anger treatment and ascertaining therapeutic gains, hinges on assessment proficiency and case formulation. Issues of validity will be delineated, and recommendations for clinical service will be given. Anger psychometrics, including use of an imaginal provocation test, will be presented.

Getting treatment engagement with chronically anger people presents multiple challenges, especially if they are seriously disordered and historically assaultive. Cognitive-behavioural anger treatment has 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 discussed. Achieving therapeutic change by addressing symbolic structures associated with anger and aggression will be illustrated. Participants will be introduced to a new group-based 18-session anger intervention, and will be given the opportunity for intensive training in that treatment protocol.

Learning Objectives
1. Familiarity with anger self-report psychometric instruments and their clinical use
2. Familiarity with staff-rated measures of anger and aggression
3. Ability to implement client self-monitoring procedures
4. Use of an imaginal provocation test for anger to assess treatment gains
5. Knowledge of key principles for engaging clients in anger treatment
6. Proficiency in arousal reduction techniques, including breathing, muscle relaxation, and imagery
7. Cognitive restructuring for anger experiences, with attention to key symbolic structures
8. Proficiency in provocation hierarchy procedures in stress inoculation format

Professor Ray Novaco pioneered the cognitive-behavioural treatment of anger. His ongoing research includes treatment studies in Scotland and England with patients in forensic facilities, combat veterans with severe PTSD, and women and children in domestic violence facilities.

Key References
Novaco, R. W. (2006). Anger dysregulation. In T. Cavell & K. Malcolm, Anger, aggression, and interventions for interpersonal violence.

Taylor, J. L., & Novaco, R. W. (2005). Anger treatment for people with development disabilities. Chicester, England: Wiley.

Novaco, R. W. (2003). The Novaco Anger Scale and Provocation Inventory manual. Los Angeles: Western Psychological Services.

Workshop 19

The Method of Levels: Helping People Resolve Psychological Distress by Regaining Control

Tim Carey, Department of Clinical Psychology, NHS Fife

Increasing and improving a client's awareness of their problem is often an implicit factor in the success of many traditional cognitive behavioural techniques. The redirection and focussing of awareness, therefore, can be considered a basic therapeutic process in cognitive therapy. Through completion of activities such as thought diaries and activity schedules clients may become more aware of the extent of their problems, important areas to target, and also their rate of improvement. Later developments such as schema focussed work, guided discovery, and mindfulness approaches also utilise the mobility of awareness to access different aspects of a client's consciousness. The method of levels (MOL) is a cognitive technique that explicitly harnesses a client's awareness to direct their attention to higher and deeper cognitive levels. MOL helps the client focus on the process by which their difficulties manifest rather than the specific content of any particular difficulty. In this way the client is enabled to become more aware of the nature of their difficulties. From this point of view a problem solving perspective is pursued and the client is assisted in generating solutions to their troubles thereby regaining control over important aspects of their lives. As a way of helping clients focus on process rather than content, MOL can be used to enhance the effectiveness of treatments for specific problems and disorders and also to address issues in the delivery of treatment such as lack of engagement, poor motivation, and resistance.

Learning Objectives:
By the end of the workshop the participants will have had opportunities to:
1. Understand the role of awareness in symptom reduction.
2. Identify the role of awareness in their current practices.
3. Explore the implications of incorporating more awareness activities in their current practices.
4. Participate in awareness focussing activities.
5. Experience shifting awareness of others through role-play.
6. Clarify the nature of control, how it can be disrupted, and how it might be restored.

Timothy A. Carey PhD is a Chartered Clinical Psychologist, cognitive therapist, and researcher. He works in the Fife Primary Care Trust and has been developing and researching MOL in clinical settings in Australia and Scotland over the last eight years. He has presented at conferences in Australia, New Zealand, Singapore, the USA, the UK, and Canada. He has conducted three-day (CSG Annual Conference, Canada, July 2005) and half day (BABCP Annual Conference, UK, July 2006) MOL workshops both of which were positively evaluated. He uses MOL in his clinical practice, supervises cognitive behavioural psychotherapists in the use of MOL, and conducts monthly MOL discussion groups.

Key References:         
Carey, T. A. (2005). Can patients specify treatment parameters? A preliminary investigation. Clinical Psychology and Psychotherapy: An international journal of theory and practice, 12(4), 326-335.

Carey, T. A. (2006). The Method of Levels: How to do psychotherapy without getting in the way. Hayward, CA: Living Control Systems.

Carey, T. A. & Mullan, R. J. (2007). Patients in Charge: A naturalistic investigation of a patient led approach to treatment in primary care. Counselling Psychology Quarterly, 20(1), 1-14.