Workshop 1

Bipolar Disorder: A Cognitive Therapy Approach

Cory F. Newman, Director of the Center for Cognitive Therapy, Philadelphia, Pennsylvania, USA and University of Pennsylvania

Course participants will learn to
o Apply a wide range of cognitive-behavioural techniques to improve the global functioning; to overcome lethargy, hopelessness, and resistance; and to reduce the risk of suicide in bipolar patients.
o Teach bipolar patients to spot their own prodromal symptoms and to apply self-help techniques before the episodes worsen.
o Appreciate the patients' needs for respect and autonomy, as well as their concerns about medications, stigma, and long-term dysfunction - and to address these in ways that support therapeutic change.
o Maximise collaboration between the prescribing physician and the non-physician therapist in the treatment of bipolar patients.

Cory F. Newman is the Director of the Center for Cognitive Therapy in Philadelphia, Pennsylvania, USA, and an associate Professor of Psychology in the Department of Psychiatry at the University of Pennsylvania. He is extremely active as a therapist, supervisor, author of dozens of publications, international lecturer (having presented workshops in 14 countries), and protocol cognitive therapist and cognitive therapy supervisor in a number of multi-site clinical trials. He is the lead author of the recently published volume, Bipolar Disorder: A Cognitive Therapy Approach (2001, American Psychological Association).

Recommended Readings:
Lam, D.H., Bright, J., Jones, S., Hayward, P., Schuck, N., Chisholm, D., & Sham, P. (2000). Cognitive therapy for bipolar disorder: A pilot study of relapse prevention. Cognitive Therapy and Research, 24, 503-520.
Newman, C.F., Leahy, R.L., Beck, A.T., Reilly-Harrington, N.A., & Gyulai, L. (2001). Bipolar Disorder: A Cognitive Therapy Approach. Washington, D.C.: American Psychological Association.
Scott, J., Garland, A., & Moorhead, S. (2001). A pilot study of cognitive therapy in bipolar disorders. Psychological Medicine, 31(3), 459-467.

Workshop 2

Collaborative Conceptualisation: Learning from Older Clients

Georgina Charlesworth, University College London & North East London Mental Health Trust and Ian James, Centre for the Health of the Elderly, Newcastle General Hospital

A key characteristic of the Beckian cognitive approach is collaboration with the client. Students of cognitive therapy are expected to set goals, and to plan and implement interventions in a collaborative way, yet the action plan for therapy is often based upon a therapist devised formulation originated outside the therapy sessions (perhaps in conjunction with their supervisor). Cognitive therapy texts generally encourage therapists to 'present' their formulation to the client and ask for feedback. Unless clients have been pre-selected for 'compatibility with the cognitive rationale' (as in some research trials) there is no particular reason why they should identify with a cognitive formulation of their difficulties. In addition, the complexity of a developmental cognitive formulation can present too great a cognitive load for the therapist and client alike. Trying to summarise decades of life experience can lead to interesting challenges in formulation diagrams, especially when combined with the multiplicity of current difficulties that are not uncommon for older clients. The aims of this mini-workshop are to introduce methods designed to increase the utility, and decrease the complexity of cognitive formulations, and to encourage a collaborative approach to conceptualisation. Participants will be encouraged to consider their clients' own explanations for their presenting problems, and to compare and contrast these with these with the cognitive rationale. Opportunities will be given to practice devising and using 'mini-formulations' based on the two-element and cognitive triad techniques for current difficulties, in addition to developing cause-and-effect diagrams and non-pathological formulations.

Recommended Readings:
Charlesworth G (1999) Cognitive therapy case formulation with older adults. PSIGE Newsletter, 69, 27-30.
James, I.A. (1999) Using a cognitive rationale to conceptualise anxiety in people with dementia. Behavioural and Cognitive Psychotherapy, 27(4), 345-351.
James, I.A. (2001) Cognitive formulations and interventions for treating distress in dementia. In Ballard, C., O'Brien, J., James, I & Swann, A. (eds) Management of behavioural and psychological symptoms in dementia. Oxford: Oxford University Press.

Workshop 3.

Cognitive Therapy for Persistent Depression

Richard Moore, Addenbrooke's Hospital, Cambridge

Numerous published studies have demonstrated the effectiveness of a range of pharmacological and psychological treatments for depression. Despite this, a sizeable minority of patients fail to respond adequately to first-line treatments. The workshop will assist participants in adapting standard cognitive therapy to the particular difficulties presented by patients with such persistent depressive symptoms. The workshop is aimed at therapists with basic training in cognitive therapy who are familiar with its application in acute depression

Learning objectives
o To familiarise participants with common difficulties that arise in applying cognitive therapy in cases of persistent depression
o To consider how the cognitive model can be adapted to help participants to develop case formulations that encompass these difficulties
o To enhance participants understanding of how different aspects of therapy, including style, techniques and delivery system, can be adapted to promote effectiveness of therapy in persistent depression

Richard Moore works as a clinical psychologist in the Psychological Treatments Service at Addenbrooke's Hospital in Cambridge. He has worked as therapist on outcome studies of cognitive therapy for recurrent and residual depression and is interested in the mechanisms of action of cognitive therapy for depression. His primary concern is the effective application of cognitive approaches within NHS settings.

Recommended Readings
Beck, J.S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press
Moore, R.G. (1996). It's the thought that counts: The role of intentions and meta-awareness in cognitive therapy. Journal of Cognitive Psychotherapy, 10, 255-269
Scott, J. (1998). Where there's a will… Cognitive therapy for people with chronic depressive disorders. In Treating Complex Cases, eds. N. Tarrier, A. Wells and G. Haddock. Chichester: John Wiley & Sons Ltd

Workshop 4

Applicable Research Methods for Practitioners

Chris Barker and Nancy Pistrang, University College London

Practitioners often feel daunted by the prospect of conducting research in a working service setting. The potential barriers are many: lack of funding, time pressures, the complexity of standard research methods, the perceived exclusivity of the academic research community, the current emphasis on randomised controlled trials, and so on. However, in the last ten years or so, some new approaches to research have appeared that may be more congenial for working clinicians. This workshop will examine the issues involved in conducting research in clinical settings, and present some of these new approaches, especially those that involve small sample sizes, such as qualitative approaches; systematic case studies; and quasi-experimental designs.

This workshop is aimed at clinicians who want to put research into practice; those who want to know about the latest research methods; or learn about accessible ways of doing research when you have little time or resources.

The workshop aims to give participants a good sense of the currently available methods for doing research in service settings and hopefully more confidence about combining research with clinical practice.

Chris Barker and Nancy Pistrang are both Senior Lecturers in Clinical Psychology at UCL (and Honorary Clinical Psychologists in Camden & Islington Mental Health Trust). They have a joint research program focussing on psychological helping processes in clinical and non-professional contexts. They are currently researching the process and outcome of mutual support for a variety of psychological problems. They have co-authored (with Robert Elliott) a widely used clinical research methods text, a second edition of which is due out this summer. They also have an interest in virtual reality applications to clinical psychology.

Recommended Readings
Barker, C., Pistrang, N., & Elliott, R. (2002). Research methods in clinical psychology: An introduction for students and practitioners. (2nd ed.) Chichester: Wiley.
Kendall, P.C., Butcher, J.N., & Holmbeck, G.N. (Eds.) (1999). Handbook of research methods in clinical psychology (2nd ed.). New York: Wiley.
Robson, C. (1993). Real world research: A resource for social scientists and practitioner researchers. Oxford: Blackwell.

Workshop 5

The Assessment and Management of High Risk or Dangerous Behaviour in Young People.

Patrick Kennedy, Northern Forensic Mental Health Service, Newcastle

Young people commit more crime per head of the population than any other age group. This phenomenon, although widely acknowledged, is often sidelined by a belief that the crimes committed by young people are petty property related crimes. Regrettably this is far from the truth. Criminal statistic trends over the years profile young people aged under 21 years, as committing approximately 1/5 of all murders, and manslaughter's, 1/3 of wounding endangering life, robberies and 1/3 of all sexual offences against children.

Society's tolerance of young offenders is evaporating rapidly and there have been many high profile cases. At no other time has the assessment of 'risk' or 'dangerousness' within the child & adolescent population been so frequently and enthusiastically requested by the Courts, Social Services Departments etc. Risk assessment in young people is a developing area. Unfortunately, the inescapable conclusion at this time is that there are no scientifically validated tools for accurately predicting levels of risk in young people. There is an urgent need therefore for practicing psychologists not only to attend to such rapidly developing trends and demands in psychological practice in an informed and professionally defensible manner, but also to update and equip themselves in the knowledge, processes, thought and development to approaches in risk assessment and intervention / management of young people.

The workshop aims to:
oIdentify the legal expectations of a psychological 'risk' assessment in England & Wales.
oDemonstrate a psychological approach to the assessment of 'risk' or 'dangerousness'.
oIdentify the limits and constraints surrounding psychological 'risk' assessment.
oPromote thought on therapeutic / intervention issues.
oDiscuss the application of relevant cognitive and behavioural intervention protocols.
oProvide opportunities for participants to discuss the implications of high-risk cases and their management within the community.

Case studies will be used to illustrate key points and opportunities for professionals to inform the Criminal Justice System and other professionals in the management of high-risk behaviours in young people. It is anticipated that the workshop presentation, case studies and attendees personal perspectives will assist and provide colleagues with an insight into the current 'hot' issues and approaches to risk assessment and intervention / management in young people.

Patrick John Kennedy is employed by the Northern Forensic Mental Health Service for Young People, in Newcastle upon Tyne. Over the last 3 years he has provided clinical and forensic psychology services to HM Young Offender Institutions, regional Youth Offending Teams and secure units in the North East including health, social care and learning disability establishments. His principal clinical and forensic research interests are in adolescent sexual and violent offending, the investigation of facial recognition and the development of personality and psychopathy, and risk management. He is a visiting postgraduate lecturer at the University of Northumbria at Newcastle.

Workshop 6

Family Focused Cognitive Behavioural Treatment of Chronic Fatigue Syndrome and Distress in Adolescents

Trudie Chalder Guy's King's and St Thomas' School of Medicine, London

Fatigue as a symptom is rarely reported in children under 14 but the prevalence rises during adolescence when increasing numbers of children with marked fatigue are being referred to secondary care.
Many of these children fulfil criteria for chronic fatigue syndrome (CFS) and a large proportion of these will have a mood disorder. Left untreated the recovery rate is much better in children than adults with about 75% improving over a two-year period. However a percentage remain significantly disabled, unable to go to school. Symptom onset is likely to be related to a combination of factors but treatment initially focuses on maintaining factors such as fearful thoughts and avoidances. Treating co-morbid depression and anxiety should not be neglected but needs to be conducted with care as to avoid alienating the family. A number of case studies have suggested that a combination of behavioural interventions linked with a family therapy approach is effective. The aim of this workshop is to describe the approach we currently use in our CFS clinic set up specifically for adolescents. Participants will be expected to practice specific skills using role-play. The emphasis will be on engaging and keeping families in treatment.

The workshop is aimed at qualified cognitive behaviour therapists. Some experience of working with adolescents may be an advantage.
By the end of the session the therapist will be able to: identify three issues that could disrupt the therapeutic relationship; describe three interventions which would help facilitate a good therapeutic relationship; identify the components of a good rationale; address emotional difficulties without alienating the family

Trudie Chalder is Reader of Psychology and Nursing in the Dept. of Psychological Medicine and Department of Psychiatric Nursing at Guy's, King's and St Thomas' School of Medicine (GKT) London. She is a cognitive behavioural psychotherapist and has worked as a clinician and a researcher in the area of chronic fatigue syndrome for about 14 years and set up the clinic for adolescents 5 years ago.

Recommended Readings
Vereker M (1992): Chronic fatigue syndrome: a joint paediatric-psychiatric approach. Archives of Disease in Childhood 67:550-555.
Chalder T, Garralda E, Johnson C, Cronk E, Pipe R, Stores G, Thompson M. (1999) Guidelines: Chronic fatigue syndrome (CFS) in children and adolescents: recommendations for Current Best Practice. In: Association of Child Psychology and Psychiatry: Occasional Papers No 16. Edited by Elena Garralda.
Chalder T, Tong J, Deary V. (2002) Family focused cognitive behaviour therapy for chronic fatigue syndrome in adolescents. Archives of Disease in Children. 86; 95-97.

Workshop 7

Cognitive Therapy in Adolescents with Anorexia Nervosa: An Integrated Approach

Anne Stewart, Highfield Family and Adolescent Unit, Oxford

This workshop will focus on the use of cognitive therapy for adolescents with anorexia nervosa. The research background on the use of CBT with eating disorders and the role of family therapy with adolescent eating disorders will be reviewed. In this workshop an approach will be presented which combines family therapy with individual cognitive therapy.

A cognitive model for the development and maintenance of anorexia nervosa in adolescence will be described. This model utilises ideas from existing models of anorexia nervosa but incorporates a systemic and developmental focus relevant to adolescents. A treatment strategy based on this model and taking account of existing research evidence will be described. The treatment has three phases, an initial family based phase where the focus is on weight restoration, a second phase using individual cognitive therapy and a final phase which incorporates family and individual approaches. Motivational issues are addressed throughout treatment. The individual cognitive therapy will be described in detail. During this treatment a range of cognitions is addressed. Strategies include identifying and challenging distorted or unhelpful beliefs, decreasing maladaptive and increasing adaptive behaviours, improving body image and developing a positive sense of self, separate from the anorexia. The integration of this approach with family work will be described. Case examples will be used to illustrate the treatment approach and participants will be encouraged to apply this model to their own work with patients. There will be opportunity in small groups to practice the strategies and discuss the issues raised.

Objectives of workshop
oTo increase awareness of the research evidence in this area
oTo increase understanding of a cognitive model of adolescent eating disorders
oTo familiarise participants with the details of a cognitive therapy intervention for adolescents with anorexia nervosa
oTo provide opportunity to discuss the problems and pitfalls in applying cognitive therapy to adolescents with anorexia nervosa

Anne Stewart is an adolescent psychiatrist working within the adolescent outpatient and inpatient mental health service in Oxford. Her special interests include eating disorders and chronic fatigue in young people and the use of cognitive-behaviour therapy in this age group. She has developed an integrated approach to the treatment of eating disorders that combines individual CBT with a family approach.
Recommended Readings
Garner, D.M. Vitousek, K.M , Pike, K.M. (1997) Cognitive-behavioural therapy for anorexia nervosa. In D.M. Garner & P.E. Garfinkel (eds.) Handbook of treatment for eating disorders pp94-144, 2nd edn. Guilford Press.
Hodes, M., Eisler, I., Dare, C. (1991) Family therapy for anorexia nervosa in adolescence: A review, Journal of the royal society of medicine, 84, 359-362.
Wilson, G.T., Fairburn, C.G. & Agras, W.S. (1997) Cognitive-behavioural therapy for bulimia nervosa. In D.M. Garner & P.E. Garfinkel (eds.) Handbook of treatment for eating disorders pp 67-93, 2nd edn. Guilford Press.

Workshop 8

CBT for Depression in Older Children and Adolescents

Chrissie Verduyn, The Children's Hospital, Manchester UK

Clinical applications of CBT to adolescents with depressive disorders will be reviewed in the light of recent outcome studies. Developmental and contextual consideration often necessitate modifications of techniques of cognitive therapy used with adults. In the real world adolescents rarely present with depression as their only problem. Depression is often not the major problem identified by referrers. Engagement into therapy may be very difficult if goals are adult-determined. Families and schools may require parallel interventions which involve working within the same model. Strategies in the flexible use of CBT in work with adolescents will be discussed including working with families, schools and carers in social service settings.
Participants will be presented with case material to clarify these points and to provide a focus for discussion. From experience in clinical supervision, the commonest reason for difficulty in working with adolescents with CBT is in the lack of initial clarity about the collaborative approach and goal setting. A clinical approach to successful engagement and goal setting and other typical difficulties will be discussed. It is hoped that participants will come prepared to discuss issues raised from their own work.
Learning Objectives: To outline key issues in using CBT with depressed adolescents to address skills in formulation and engagement of young people with complex presentations

Chrissie Verduyn works as a clinical psychologist with children, adolescents and their families in Manchester and Salford. She has had a longstanding interest in CBT with depressed young people both in clinical service provision and research trials. She has had experience of training child mental health professionals in CBT nationally and internationally.

Recommended Readings
Harrington R C, Wood A J & Verduyn C M (1998) "Clinically Depressed Adolescents" in Graham P (ed) Cognitive behaviour therapy for children and families. Cambridge University Press: Cambridge UK
Harrington R C, Whittaker J, Shoebridge P et al (1998) Systemic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder. British medical journal 316 1559-1563.
Verduyn Chrissie (2000) Cognitive behaviour therapy in childhood depression. Child Psychology and Psychiatry Review. Vol 5 4 176-180.

Workshop 9

Cognitive Behaviour Therapy for Traumatic Psychosis

Pauline Calcott, Cognitive Therapy Department, and Douglas Turkington, Department of Psychiatry, Newcastle.

Level aimed at: experience of CBT use in psychosis and knowledge of models of CBT action in PTSD would be beneficial.

The learning objectives:
To understand the links between different types of trauma and different types of psychotic symptoms.
To see the meaning of the symptoms in relation to trauma and to be able to formulate the case.
To be clear about the need for symptom rating and ongoing risk assessment.
To be able to see how to use PTSD techniques with psychotic patients.
To be able to understand the various schema strategies which can be used in this situation.

Recommended Readings
Smucker M. & Dancu C. (1999) Cognitive-Behavioral Treatment for adult survivors of childhood trauma: imagery rescripting and processing. Jason
Oronson. London
Ehlers A. and Clark D. (2000) A model of persistent PTSD. Behavior Research and Therapy. Vol.38 319-345
Rusch M., Grunert B. Mendelsohn R, Smucker M (2000) Imagery rescripting for recurrent distressing images. Cognitive and Behavioral Practice, 7(2),
173-182.
Mueser KT, Rosenberg SD, Goodman LA, Trumbetta S.L. (2002) Trauma, PTSD, and the course of severe mental illness: an interactive model. Schizophrenia Research. Vol. 53 (1-2): 123-43

Workshop 10

Cognitive Behaviour Therapy for Body Dysmorphic Disorder

Fugen Neziroglu, Hofstra University, New York, USA and
David Veale, Grovelands Hospital & Royal Free School of Medicine, London

Body Dysmorphic Disorder (BDD) is defined as a preoccupation with an "imagined" defect in one's appearance or where there is a slight physical anomaly, the person's concern is markedly excessive. Most individuals are preoccupied by multiple concerns around their face but any part of the body may become the focus. They may spend several hours a day checking in mirrors or comparing themselves to others. They often have needless dermatological treatment or cosmetic surgery or may perform "D.I.Y" surgery. They have a poor quality of life, are socially isolated, depressed and are at high risk of committing suicide.

Learning Objectives:
1. Review the diagnostic criteria and clinical features of body dysmorphic disorder
2. Assess patients with BDD and use of rating scales
3. Review efficacy of CBT in individual and group therapy
4. Review a cognitive behavioural model of BDD and develop a formulation
5. Engage a patient with BDD
6. Learn strategies for social anxiety, mirror gazing, skin-picking
7. Learn strategies for perfectionism and ideals about the importance of appearance.
8. Review pharmacotherapy guidelines for BDD.

These goals will be accomplished via lecture, videotapes and role-playing. Participants are encouraged to bring their own cases to role-play treatment.

Recommended Readings
Geremia, G., & Neziroglu, F. (2001). Cognitive Therapy in the treatment of body Dysmorphic disorder. Clinical Psychology and Psychotherapy, 8, 243-251.
Veale, D, Gournay, K, Dryden, W, Boocock, A. Body Dysmorphic Disorder: a cognitive behavioural model and a pilot randomised controlled trial. Behaviour, Research and Therapy, 1996; 34, 9:717-729.
Veale, D. Cognitive Behaviour Therapy for Body Dysmorphic Disorder. Advances in Psychiatric Treatment, 2001; 7: 125-132.
Yaryura-Tobias, J.A., & Neziroglu, F. (1997). Bio-behavioral treatment of obsessive-compulsive spectrum disorders. Boston:Norton.

Workshop 11

CBT for Traumatized Refugees and Asylum Seekers

Kerry Young, Traumatic Stress Clinic & UC, and
Nick Grey, Centre for Anxiety Disorders and Trauma, Maudsley Hospital, London

Who the workshop is aimed at (inc level of previous CBT experience required):
It should be suitable to clinicians of all levels, but some experience of both treating PTSD and working with asylum seekers and refugees would be advantageous. Familiarity of the general cognitive model and basic clinical skills are assumed.

The learning objectives:
Increasingly clinicians are working with asylum seekers and refugees who present with multiple psychological and social problems. Almost invariably these clients have faced one or, more usually, a number of traumatic events both in their country of origin and also the UK. There are relatively few guidelines as to how best to approach treatment and therapists sometimes have unhelpful beliefs of their own about the difficulty of working with such cases. This workshop will outline a possible treatment pathway for clinicians to follow. This includes the role of asylum status, housing, and developing / integrating into social networks. Specific cognitive behavioural strategies to address depressive and posttraumatic stress symptoms will be detailed, including discussion of when and how to best use reliving / exposure techniques. Direct comparisons will be made between using 'testimony' and cognitive-behaviour therapy. The workshop will also address the issue of working with interpreters / translators. The main message for clinicians to take away is that they have the basic skills to work with such cases and that with careful thought about the timing and particular application of interventions progress can be made.

By the end of the workshop participants should:
· Have a greater understanding of psychological presentations, especially PTSD and Depression, within asylum seeker and refugee populations.
· Be able to plan a coherent treatment approach in difficult cases, including how and when to use reliving / exposure techniques.
· Feel more confident about working with such cases, including the use of interpreters.

Kerry Young, Traumatic Stress Clinic, Camden & Islington NHS Trust, & University College London, and Nick Grey, Centre for Anxiety Disorders and Trauma, Maudsley Hospital, & Institute of Psychiatry. Both presenters have worked for many years in specialist outpatient trauma services for adults including working with asylum seekers and refugees, particularly survivors of torture.

Recommended Readings
Basoglu, M. (Ed.) (1992). Torture and its Consequences: Current Treatment Approaches. Cambridge: Cambridge University Press.
Ehlers, A. & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research & Therapy, 38, 319-345.
Van der Veer, G. (1998). Counselling and Therapy with Refugees and Victims of Trauma: Psychological Problems of Victims of War, Torture and Repression (2nd ed.). Chichester: Wiley.

Workshop 12

Cognitive Behaviour Therapy for School Refusal

Veira Bailey, Maudsley Hospital &
Linda Langdon, Teacher-in-Charge of the Day Unit, Hounslow CAMHS, London

School refusal occurs in approximately 50% of clinic referrals and in 1% of all school age children. There is major conflict and distress in the family; the child frequently becomes disadvantaged educationally and socially; and is at risk of disabling social phobia and agoraphobia in adult life.

The Hounslow School Return Programme involves the use of CBT in a group setting for school refusing children and adolescents. This programme is a structured rapid return to school in which behavioural rewards are used to reinforce success and cognitive strategies are taught within a group setting to help the child or adolescent cope with anxiety. Work is done simultaneously with parents teaching contingency management skills and challenging maladaptive cognitions, combined with intensive school liaison.

Retrospective outcome data will be presented indicating 100% success in an uncontrolled series of 38 school refusers defined according to Berg's criteria.

The workshop will include both didactic input and an opportunity for participation in role-play of techniques.

Workshop 13

Cognitive Behaviour Therapy with Traumatised Adolescents

David Trickey, Child Psychologist, Traumatic Stress Clinic, London

By the end of this workshop, the participants should have a good knowledge of:
· How children and families react to trauma
· Methods of assessing reactions to trauma
· How CBT can explain these reactions
· How to assist children and families following trauma, using CBT.
· The particular difficulties in engaging traumatised adolescents.

The Ehlers and Clark (2000) paper will be presented as a framework for applying CBT to traumatised individuals. This will then be explored in relation to working with adolescents. The difficulties of engaging adolescents will be examined and potential solutions will be generated. Systemic influences on this client group will be discussed and methods for intervening at various level of the system in which adolescents find themselves will be presented.

The workshop will use a variety of training methods including:
· Interactive presentation of theory with case illustrations (with clients' consent)
· Small group discussion fed back to the whole group
· Individual exercises
· Video clips (assuming either video or LCD projector available)

David Trickey worked for the Clinical Psychology Service for Children and Families in South Lincolnshire for 6 years before joining the Traumatic Stress Clinic Child and Family Service where he has been part of the small multi-disciplinary team for two years. His current research interests include concentration problems of traumatised children, sleep problems in traumatised families and outcome measurement.

Recommended Readings
Ehlers, Anke and Clark, David M. (2000) A cognitive model of posttraumatic stress disorder. Behaviour Research & Therapy. Vol. 38(4), 319-345.
Black, D., Newman, M., Harris-Hendriks, J., & Mezey, G. (eds.) (1997) Psychological Trauma: A Developmental Approach. Gaskell/RCP

Workshop 14

Cognitive Therapy for Bulimia Nervosa

Myra Cooper, Isis Education Centre, Warneford Hospital, Oxford &
Gillian Todd, University of Cambridge.

BN is a distressing, common and disabling disorder that can be very difficult to treat successfully. This workshop will present new developments in cognitive therapy (and theory) for bulimia nervosa (see Cooper, Todd & Wells, 2000). It is designed for practitioners of all levels who want an introduction to recent advances in the treatment of the disorder. Primarily skills based, it will teach participants how to develop a detailed conceptualisation of binge eating - taking into account different types of automatic thought (e.g. permissive thoughts, thoughts of no control, positive and negative thoughts about eating), feelings and behaviour. Techniques to identify and challenge these thoughts will then be explained. This will include behavioural experiments and specially designed thought records. The role of behaviours in maintaining the disorder will be covered, and how to tackle these will also be explained. Participants will also learn how to develop a detailed conceptualisation of factors that may be important in the development of the disorder. This will take into account underlying assumptions, core (negative self) beliefs, and early experience. Techniques to identify and challenge these beliefs will be presented and explained. This will include the application of "state of the art" core belief strategies such as historical tests of beliefs and cognitive continua to bulimia nervosa.

Learning objectives: Participants will learn how to conceptualise bulimia nervosa using new developments in theory. This will include both the maintenance and development of the disorder. Participants will also learn how to apply novel, "state of the art" techniques to work with the thoughts and beliefs identified in such a conceptualisation.
Training modalities: These will include opportunity for experiential learning. Video material and examples from the authors' practice will also be presented.

Myra Cooper is Research Tutor on the Oxford Doctoral Course in Clinical Psychology. She is an experienced cognitive therapist and supervisor, with a special interest in eating disorders. She is also an experienced researcher.
Gillian Todd is a cognitive therapist at the University of Cambridge. She has many years' experience of working with eating disorders. She is currently working towards a PhD in the field.

Recommended Readings
Cooper, M.J., Todd, G. & Wells, A. (2000). Bulimia nervosa: a self help cognitive therapy programme for clients. London: Jessica Kingsley.

Workshop 15

The Dissemination of Family Approaches to Psychosis

Grainne Fadden, University of Birmingham.

Psychoeducational family approaches based on cognitive behavioural principles are evidence-based, and their efficacy has been demonstrated over the past two decades. However, their implementation in practice is not widespread in clinical services. There are several reasons for this linked with historical issues, models of pathology, which are widely accepted, and issues in service systems, which impede change.

The author has extensive experience in implementing family work in clinical service and the obstacles encountered and lessons learned in doing this have wide applicability to all areas of cognitive and behavioural approaches. This half-day workshop will outline the key obstacles that impede widespread dissemination of psychosocial or cognitive-behavioural approaches. These include the professional training of staff, attitudes of workers, reluctance to change to new ways of working and the core obstacle that these approaches are not seen as 'core business' but rather as 'optional extras'.

The author will then describe strategic interventions in services to enable the more widespread use of these approaches. These include ways of working with management to facilitate change and effective methods of training staff. Participants will have the opportunity to work on examples from their own services.

Workshop 16

Teen Triple P for Parents of Teenagers: A Transition to High School Early Intervention

Alan Ralph, University of Queensland, Queensland, Australia

A multi-level cognitive-behavioural family intervention for parents of young teenagers. Participants will be introduced to the content and rationale of the Group Teen Triple P (Positive Parenting Program) as it relates to parents of teenage children. This will include early detection and management of teenage behaviour problems; risk and protective factors operating within families; core principles of positive parenting and behaviour change; advanced assessment of child and family functioning; application of key parenting strategies to a broad range of target behaviour; strategies for promoting generalisation and maintenance of behaviour change; and the identification of indicators suggesting the presence of additional risk factors within families.

Alan Ralph took up a position as Associate Professor of Clinical Psychology at the University of Queensland in July 2001. He has spent much of the last 12 years training Clinical Psychologists to work effectively with children, adolescents, their parents, and their teachers, while maintaining a small clinical practice.

Workshop 17

Exposing Fear of Pain: Tackling Avoidance in Clinical Settings

Zoë Clyde, Rachel Harman, and Annie Moreland, INPUT Pain Management Unit, St Thomas' Hospital, London

This workshop is aimed at those who are interested in the application of CBT in a clinical setting. We will explore the rapidly developing area of assessment and treatment of pain-related fears, which are powerful determinants of patients' behaviour. The format will be interactive, involving voluntary discussion of participants' own fears and those of the patients they work with. Group work and discussion will be used to explore case material.

We aim to increase your understanding of pain-related fear, and its implications for daily functioning. This will involve exploring the connection between fear, cognition and avoidance. The importance of cognitive processes such as catastrophising and the meaning of fear to individual patients will be discussed.

Assessment of pain-related fears is complex. For example, when a patient says, 'I physically can't get on the floor', the reason for this is not clear. Patients rarely present fear as the reason for stopping activity. It is hard for health professionals to identify whether avoidance of activity is due to a lack of practice and hence confidence in general, or due to a specific pain-related fear. We will introduce assessment tools that are currently in use in chronic pain management settings and discuss the practical implications of their use.

Evidence has shown CBT, which involves graded activity, is effective for chronic pain management (Morley et al.1999). Single case studies have shown graded exposure to be more effective than graded activity in addressing pain-related fears (Vlaeyen et al.2001). The danger of missing pain-related fears and using graded activity rather than graded exposure is that it can lead to the confirmation of the patient's worst fear and result in further avoidance undermining their success in applying pain management skills

We suggest that pain-related fear is not confined to chronic pain settings. It is hoped that discussion, drawing on participants' clinical experiences, can lead to the identification of other clinical settings where pain-related fear occurs and where the assessment and treatment methods highlighted can be used.

Learning Objectives:
Introduction to the cognitive model of fear of movement and (re) injury and its implications for managing chronic pain
The issues surrounding assessment of pain-related fears
Discussion around the differences between graded activity (GA) and graded exposure (GE)
The wider application of these techniques to other clinical settings

Recommended Readings
Crombez, G., Vlaeyen, J.W.S., Heuts, P.H.T.G., Lysens, R. (1999). Fear of pain is more disabling than pain itself. Evidence of the role of pain-related fear in chronic back pain disability. Pain, 80, 329-339.
Morley S.J., Eccleston C., Williams A. CdeC (1999). Systematic review and meta-analysis of randomised controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80, 1-13.
Vlaeyen J.W.S., Linton S.J. (1999). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85, 317-332.