Workshop 3

Clinical Implementation of CBT for OCD: Delivering Effective Outpatient and Intensive Treatments

Paul Salkovskis and Victoria Bream, Institute of Psychiatry, London

OCD is frequently regarded as chronic and difficult to treat. This is at odds with research findings and recent NICE guidelines which indicate that CBT is a highly effective treatment. This workshop aims to provide an overview of the theoretical background that informs treatment and the details of treatment itself. The main focus of the workshop will be on formulating obsessional problems, including the beliefs held about responsibility for harm and maintaining factors. A key message will be the value of collaboratively devising an alternative non­threatening belief that guides the use of behavioural experiments in treatment. The adaptation of treatment to an intensive format will be discussed and illustrated.

Key Learning Objectives

To be able to treat OCD based on techniques developed from the Salkovskis (1985) model. To be able to formulate using the threat appraisal/beliefs about responsibility that is key to the problem, and the maintaining role of rituals, rumination, selective attention and avoidance.

• To understand the model, and use it to formulate.
• To understand the value of, and be confident to use behavioural experiments.
• Use of metaphors in treatment.
• To be able to adapt treatment for use in an intensive format.

Professor Paul Salkovskis is the Clinical Director of the Centre for Anxiety Disorders and Trauma at the Maudsley Hospital, London. He is Professor of Clinical Psychology and Applied Science at the Institute of Psychiatry. Dr Victoria Bream is a Clinical Psychologist at the Institute of Psychiatry, working at the Centre for Anxiety Disorders and Trauma.

Key References

Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, p29-p52. Salkovskis, P. M., E. Forrester, et al. (1998).

The devil is in the detail: conceptualising and treating obsessional problems. Cognitive therapy with complex cases. N. Tarrier, Wells, A., Haddock, G. (eds). Chichester, Wiley.

Workshop 4

Working with Shame and Developing Self-Compassion

Paul Gilbert, Kingsway Hospital and Deborah Lee, UCL and Oxford Cognitive Therapy Centre

The workshop will explore the varied presentations of shame and distinguish between internal and external shame. The workshop will help participants distinguish between shame, embarrassment, guilt and humiliation, and think about shame in the therapy relationships itself. Internal shame will be linked to different types of self-criticism and we will explore the importance of a functional analysis of self-criticism.

The second part of the workshop will focus on what is called compassionate mind training (CMT). Shame-prone and highly self-critical-people can have problems accessing warmth and soothing, positive affect systems. Recent work suggests, however, that developing self-compassion/soothing can have a useful role in healing shame and this enables people to feel safer. CMT interventions is aimed at: developing empathy for one's own distress, a compassionate focus to thinking and behaviour, and development of the affect of inner warmth. By the end of this workshop participants will be familiar with some techniques to stimulate compassionate mind processing.

Key Learning Objective

• To learn how to identify shame and develop compassion focused interventions.

Paul Gilbert is Professor of Clinical Psychology at the University of Derby, a Consultant Clinical Psychologist in Adult Mental Health, and Head of the Mental Health Research Unit for the Derbyshire Mental Health Trust. He is Fellow of the British Psychological Society, past president of the BABCP and has written extensively in the areas of mood disorder and shame and compassion focused therapy. Deborah Lee specialises in working with traumatised people, co-runs the Oxford Cognitive Therapy Trauma Service, and has developed compassion focused therapy for Trauma.

Key References

Gilbert, P., & Andrews, B., [1988] Shame: Interpersonal Behavior, Psychopathology and Culture. New York: Oxford University Press.

Gilbert , P. [2005] Compassion: Conceptualisations, Research and Use in psychotherapy. London. Routledge.

Workshop 8

The Assessment of Abuse Within Severe Mental Health Problems: When and How to Ask About Child Abuse, and How to Respond to Disclosures

John Read, University of Auckland, New Zealand
Paul Hammersley, University of Manchester
Peter Bullimore, The Hearing Voices Network

Despite the proven relationships between adverse life events, especially in childhood, and a range of mental health problems, research shows that many users of mental health services are never asked about child abuse or neglect. This workshop is based on a training programme which has been used in New Zealand for the past four years to redress this situation.

Key Learning Objectives

1 To motivate mental health staff to ask all their clients about child abuse, by summarising the research showing its high prevalence among users of mental health services and its relationship to most mental health problems (including psychosis).
2 To learn when, and how, to take a trauma history.
3 To learn how to respond to a disclosure of childhood sexual, physical or emotional abuse.

John Read is a Senior Lecturer in the Clinical Psychology programme at the University of Auckland, New Zealand. He is the coordinating editor (with co-editors Richard Bentall and Loren Mosher) of 'Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia'. London: Brunner-Routledge, 2004. John is a member of the Executive Committee of the International Society for the Psychological Treatments of Schizophrenia (ISPS) www.isps.org. His main research areas are the social causes of psychosis and the detrimental effects on stigma of bio-genetic causal beliefs. He has also conducted research into the extent to which abuse histories are taken, and adequately responded to, and the reasons clients are so rarely asked about abuse. For more information: www.psych.auckland.ac.nz/Psych/staff/JohnReadhtm

Key References:

Read, J., Goodman, L., Morrison, A., Ross, C., Aderhold, V. Childhood trauma, loss and stress. In J. Read, L. Mosher, R. Bentall (eds.) Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. London: Brunner-Routledge, 223-252, 2004.

Young, M., Read, J., Harrison, R. The need for training of mental health professionals in how and when to take abuse histories. Professional Psychology: Research and Practice, 32, 407-414, 2001.

Cavaanagh, M., Read, J., New, B. Sexual Abuse Inquiry and Response: A New Zealand Training Programme. New Zealand Journal of Psychology, 33, 137-144, 2004.

Workshop 9

Staying Well After Psychosis: A Cognitive Interpersonal Approach to Relapse Prevention and Emotional Recovery

Andrew Gumley, University of Glasgow and Matthias Schwannauer, University of Edinburgh

This workshop on staying well after psychosis presents an individually based psychological intervention targeting emotional recovery and relapse prevention. Our approach considers the cognitive, interpersonal and developmental aspects involved in recovery and vulnerability to the recurrence of psychosis. The workshop will outline an overall psychological framework for developing individually tailored strategies for case formulation, recovery and staying well that primarily focus on emotional and interpersonal adaptation to psychosis. This approach incorporates:

1 A developmental perspective on help seeking and affect regulation,
2 Strategies to support self reorganisation and adaptation after acute psychosis,
3 Understanding and treating traumatic reactions to psychosis,
4 Working with feelings of humiliation, entrapment, loss and fear of recurrence appraisals during recovery,
5 Working with cognitive interpersonal schemata, and
6 Developing coping in an interpersonal context.

Key Learning Objectives

1 To formulate emotional recovery and relapse prevention as reciprocal goals requiring the development of psychological adaptation and affect regulation skills.
2 To incorporate a developmental perspective to guide the process of service engagement, formulation and intervention.
3 To develop individualised formulation based approach to emotional recovery, relapse detection and prevention.
4 To develop a therapeutic frame around the interplay between interpersonal schemata, and under­developed and over-developed coping strategies.

Andrew Gumley is Senior Lecturer in Clinical Psychology at the University of Glasgow and Honorary Consultant Clinical Psychologist at ESTEEM: North Glasgow Early Intervention Service. Matthias Schwannauer is Lecturer in Child and Adolescent Clinical Psychology at the University of Edinburgh and Consultant Clinical Psychologist in the Adolescent Onset Psychosis Service in Edinburgh.

Key References

Gumley A, O'Grady, M, McNay, L, Reilly, J, Power, K & Norrie, J (2003). Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychological Medicine, 33, 419-431.

Gumley AI & Schwannauer M. (2006) Staying well after psychosis: a cognitive interpersonal approach to recovery and relapse prevention. Chichester: John Wiley & Sons Ltd.

Workshop 10

Uniting Head and Heart: The Power of Behavioural Experiments in Cognitive Therapy

Martina Mueller and David Westbrook, Oxford Cognitive Therapy Centre

Behavioural experiments have long been recognised as a powerful agent for change in cognitive therapy. This workshop addresses the process by which cognition and behaviour interact to maintain problems and prevent unhelpful perspectives from being updated in the light of experience.

Key Learning Objectives

Participants will focus on:

• Designing behavioural experiments to target the content and process of cognition, at the level of automatic thoughts, assumptions and core beliefs.
• Maximising opportunities for learning through experience.
• Evaluating the results of the experiments, and reflecting on their implications.

The presenters are both experienced practitioners with a reputation for offering high quality training and supervision through OCTC, and this workshop has been highly acclaimed in the UK, the USA, Sweden & Australia. Martina Mueller also has expertise in the treatment of complex PTSD and David Westbrook has interests in service evaluation research and OCD, and is Director of OCTC. Both are editors of The Oxford Guide to Behavioural Experiments in Cognitive Therapy.

Key References:

Bennett-Levy, J. Butler, G., Fennell, M.J.V. Hackmann, A., Mueller, M. & Westbrook, D. (Eds.) (2004). The Oxford Guide to Behavioural Experiments in Cognitive Therapy. Oxford University Press, Oxford.

Workshop 11

Between Guided Self-help and Therapy: The Role of Minimal Interventions in the Treatment of Anxiety and Depression in Primary Care

Karina Lovell and Janine Fletcher, University of Manchester

Stepped care is considered to be the new model of working to provide accessible, effective and efficient care for delivering psychological and pharmacological interventions for mental health disorders particularly in primary care. Some, but not all of the NICE guidelines (eg depression, PTSD and OCD) argue that stepped care is a useful model for organising and delivering care. However, clarity is required to understand the gap between self-help and traditional therapy of between 12-20 sessions. There is confusion about the step between these 2 levels of intensity i.e. the role of minimal interventions. This workshop aims to examine the role, evidence base and application of CBT based minimal interventions for anxiety and depression in primary mental health care.

Key Learning Objectives

1 To critically examine the stepped care model and understand the underlying principles. 2 To examine the concept of and evidence base of CBT based minimal interventions. 3 To practice delivering minimal interventions with a range of anxiety and depressive disorders.

Karina Lovell is a Professor of Mental Health at the University of Manchester and also works in various clinical practice settings. Most of her research and clinical work lies in delivering accessible and effective interventions with anxiety and depression in primary care. Janine Fletcher is a mental health CBT nurse currently completing her PhD into case management for depression funded by the Department of Health. She also works for NIMHE as Project manager of a Collaborative involving the implementation of graduate workers using self help interventions within a stepped care model of service delivery. She has managed a number of primary care mental health services and has conducted research into the effectiveness of self help intervention s. 19-21 JULY 2006

Key References

Bower & Gilbody (2005) Stepped Care in Psychological Therapies: Access, effectiveness and efficiency. British Journal of Psychiatry, 186, 11-17

Lovell, K. & Richards, D.A, (2000) Multiple access points and levels of entry (MAPLE): ensuring choice, acceptability and equity for CBT services. Behavioural and Cognitive Psychotherapy, 28, 379-391.

Fletcher, J., Bower, P., Richards, D. & Saunders, T. (2004) Enhanced Services Specification for depression under the new GP contract: a commissioning guidebook. National Institute for Mental Health in England - Northwest Development Centre

Workshop 12

Cost-effective Methods of Treating Panic Disorder and Agoraphobia

Ann Hackmann, Warneford Hospital, Oxford; Institute of Psychiatry, London; and Oxford Cognitive Therapy Centre and Ruth Collins, Warneford Hospital, Oxford

NICE guidelines suggest that CBT is the treatment of choice for patients suffering from panic disorder with or without a significant degree of agoraphobia. However, the treatment for panic disorder (with mild or moderate agoraphobia) typically takes about twelve sessions, plus follow up sessions, making it difficult to deliver in the NHS with its shortage of resources. In addition, patients with more severe agoraphobia and/or other co-morbid problems may find it difficult to reach the clinic, and hard pressed clinicians find it difficult to find time to do home visits and behavioural experiments in real life settings. There may also be other issues to address, such as depression, separation anxiety or low self-esteem.

Firstly this workshop outlines a CBT approach to panic disorder and agoraphobia, and provides self-help materials to augment the clinician's input in therapy sessions. These self-help materials have been utilised in a treatment trial, in combination with five hours of treatment, with good results, for people with not greater than a moderate level of agoraphobic avoidance.

Secondly the workshop describes a project in which psychology graduates have been trained to work as volunteers, treating more severe cases of agoraphobia, who could not easily reach the clinic. Two days of training have been followed by group supervision, with excellent results. The results will be presented and discussed, in the context of ideas about how to utilise the skills of graduate workers. The workshop will provide details of a training package which has been successfully implemented in Oxford. Each participant will receive copies of the training materials, and guidance on how to organise, evaluate and supervise the work. This project has provided an innovative approach to a chronic, disabling and often untreated condition, at very low cost to the Health Service. It has also been fun to work in this way, with enthusiastic volunteers, and satisfied patients.

The workshop is suitable for those with intermediate or advanced cognitive therapy skills.

Key Learning Objectives

1 Participants will be given a detailed overview of the treatment of panic disorder, and how it can be adapted for those with severe agoraphobia, in a cost-effective manner.
2 Self-help materials will be available, for use between treatment sessions, to shorten treatment time.
3 Information on how to train and support graduate workers to treat patients with panic disorder and agoraphobia will be provided, together with useful references and handouts.

Ann Hackmann has worked with David Clark's research group since 1986, and was a therapist in two panic disorder treatment trials. In addition she has done treatment experiments with Paul Salkovskis on the importance of safety behaviours in the maintenance of agoraphobia. She now works on PTSD with Anke Ehlers and David Clark's research group at the IoP and in Oxford. She is also working on intrusive memories in depression with Chris Brewin. She is one of the editors of the Oxford Guide to Behavioural Experiments in Cognitive Therapy. Ruth Collins works with Ann in Oxford, as part of the Wellcome research group described above. She has been an enthusiastic volunteer on the agoraphobia project described above.

Key References

Clark, D.M., Salkovskis, P.M., Hackmann, A., Middleton, H., Anastasiades, P., & Gelder, M.G. (1994). A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry, 164, 759-769

Clark, D.M., Salkovskis, P.M., Hackmann, A., Wells, A., Ludgate, J., & Gelder, M.G. (1999). Brief cognitive therapy for panic disorder: a controlled trial. Journal of Consulting and Clinical Psychology. 67, 583-589.

Hackmann, A. (1998). Cognitive therapy with panic and agoraphobia: working with complex cases. In N. Tarrier, A. Wells, & G. Haddock (Eds.), Treating Complex Cases. (pp. 27-45). Chichester: John Wiley & Sons Ltd.

Workshop 13

Reflection in Practice: Applying a Developmental Model to Ourselves as Therapists, Trainers and Supervisors

Background
How many of us have sat at all-day workshops while workshop leaders describe their new theory and research - and come away none the wiser about working with actual patients?   Cognitive therapists have models of disorders aplenty.  But until recently we have had few useful models for conceptualizing

1. The skills that we’re trying to learn
2. Our own learning process as therapists
3. The best strategies for learning 

For a discipline raised on a diet of evidence-based research and practical theory, these are strangely murky areas. 

Learning objectives
In this workshop, a new model of therapist skill development (Bennett-Levy, 2006) – the Declarative-Procedural-Reflective (DPR) Model - will be presented which seeks to shed light on these issues.  The model has the capacity to pinpoint more accurately the kinds of difficulties therapists might have, and to suggest what training strategies may be most useful in overcoming them.  The aim of the day is for participants to familiarise themselves with the model and use it to guide their thinking about their own development and that of supevisees/trainees.  Specifically the objectives are:-

1. For participants to develop a practical familiarity with the DPR model
2. To consider their own strengths and weaknesses as therapists in the light of the model
3. To use the model to determine the best strategies to train different kinds of skill – and to apply it to their own learning, and/or that of supervisees
4. To leave with a coherent conceptual framework for thinking about therapist skill development, and a range of new ideas to experiment with
5. To stimulate enthusiasm as trainers, supervisors and self-supervisors

Teaching Methods
The workshop will be practical and experiential, and aims to be intellectually stimulating (while trying not to leave people in a smouldering heap). It will draw heavily on participants’ own artful experience as trainers and supervisors, and provide a scientific context for clarifying some of murkier elements of therapist skill development.  There will be skills and strategies self-assessments; experiential work in pairs and small groups; didactic presentation, and large group discussion.  It is hoped to achieve a healthy balance between structure and informality.

References
Bennett-Levy, J. (2006).  Therapist skills: A cognitive model of their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 34, 57-78.

Bennett-Levy, J. & Thwaites, R. (in press). Self and self-reflection in the therapeutic relationship: A conceptual map and practical strategies for the training, supervision and self-supervision of interpersonal skills. To appear in: P. Gilbert and R. Leahy (eds): The therapeutic relationship in cognitive therapy.  Routledge, London.

Bennett-Levy, J. & Padesky, C. (submitted for publication). Learning cognitive therapy skills: Reflection is important.

James Bennett-Levy is Consultant Clinical Psychologist with Oxford Cognitive Therapy Centre. He is an experienced trainer and researcher on cognitive therapy training, recognized particularly for his development of a self-experiential training strategy known as self-practice/self-reflection (SP/SR) and more recently for his Declarative-Procedural-Reflective model of therapist skill development.  He is also one of the editors of the Oxford Guide to Behavioural Experiments in Cognitive Therapy.

Workshop 14

CBT-Multi step for Eating Disorders

Riccardo Dalle Grave, Department of Eating and Weight Disorder, Villa Garda Hospital, Italy

This workshop describes a novel model of cognitive behaviour therapy (CBT) for eating disorders called CBT-Multi-Step (CBT-MS). The treatment, derived from the transdiagnostic cognitive behaviour theory of eating disorders described by Fairburn, Cooper, and Shafran (2003), expands the range of applicability of standard CBT. It is designed to be applicable to different levels of care (outpatient, intensive outpatient, day-hospital, inpatient, and post-inpatient), and to eating disorder patients of all diagnostic categories, ages and BMI. Distinguishing CBT-MS is the adoption of an unique theory at different levels of care, the multi-step approach conducted by a multidisciplinary (but non eclectic) team, the inclusion of a CBT family module for patients < 18 years, and the adoption of a manualised treatment in a 'real world' setting.

Key Learning Objectives

1 Participants will gain knowledge on how to adapt cognitive behaviour theory and treatment at different level of care 2 Participants will gain knowledge on how to develop a multidisciplinary but 'not eclectic team' 3 Participants will gain knowledge on how to apply a manualised treatment in a 'real world' setting.

Medical Doctor, Psychotherapist and Specialist in Nutrition and Endocrinology. He completed his training in Cognitive-Behavior Psychotherapy at the Associazione di Psicologia Cognitiva, Rome. Head of Department of Eating and Weight Disorder at Villa Garda Hospital Italy, director and teacher of the annual course for health professionals,'1 Certificate in Eating Disorder and Obesity'. He is founding member and president of Associazione Italiana Disturbi dell'Alimentazione e del Peso (AIDAP) and a Member of European Council of Eating Disorders, of the Eating Disorders Research Society and the Accademy of Eating Disorder.

Key References

Dalle Grave, R. (2005). A multi-step cognitive behaviour therapy for eating disorders. Eur Eat Dis Rev, 13, 373-382.

Fairburn, C.G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A "transdiagnostic" theory and treatment. Behav Res Ther, 41(5), 509-528.

Workshop 15

Contextual Cognitive Behavioural Therapy for Chronic Pain: Applications of Acceptance, Mindfulness, and Values

Lance McCracken and Jeremy Gauntlett-Gilbert, Pain Management Unit, Royal National Hospital for Rheumatic Diseases, Bath

This workshop addresses contextually-based approaches within the behavioural and cognitive therapies. Recent developments in our understanding of pain and suffering have led to increasing integration of established approaches, such as traditional behaviour therapy and Cognitive-Behaviour Therapy (CBT) with relatively new developments, such as Acceptance and Commitment Therapy (ACT), and mindfulness-based treatments. In the areas of chronic pain treatment, this integration is referred to as Contextual Cognitive-Behavioural Therapy (CCBT). This workshop aims to present an integrative model of chronic pain, summarise relevant research regarding CCBT, highlight treatment principles, and provide demonstrations of clinical techniques.

We aim to give examples of how skills training in mindfulness can complement acceptance-based cognitive behaviour therapy. Acceptance-based interventions include cognitive de-fusion, values clarification, and exposure-based exercises. These approaches work well in moments of difficulty and pressure, when patients can feel quite stuck, such as when patients face experiences that are physically or emotionally painful. These techniques will be demonstrated by clinicians with extensive experience in 'classical' CBT approaches, but who have increasingly applied contextually-based methods and mindfulness during a combined period of 15 years.

The workshop will address how CCBT compares and contrasts with 'classical' CBT. Implications for therapist style and treatment delivery will be made explicit. Our clinical examples will be from group-based therapy for people with chronic pain and physical health problems. However, the theory and techniques can generalise to many treatment settings.

Key Learning Objectives

By the end of the workshop, participants should:

• Be able to define key feature of CCBT and related therapies
• Note differences and similarities between these approaches and classical CBT
• Understand principles that guide CCBT
• Understand the current level of empirical support for CCBT and similar approaches
• Gain familiarity with a range of treatment methods from ACT and mindfulness-based approaches and practise these techniques.

Lance McCracken is a Consultant Clinical Psychologist and Clinical Lead of the Bath Pain Management Unit. He has published widely on contextual acceptance-based approaches to pain and disability. Jeremy Gauntlett-Gilbert is a Clinical Psychologist at Bath Pain Management Unit.

Key References

McCracken, L. M. (2005). Contextual Cognitive Behavioral Therapy for Chronic Pain. Progress in Pain Research and Management, Volume 33. Seattle: IASP Press.

McCracken LM, Eccleston C (2003) Coping or acceptance: what to do about chronic pain? Pain, 105, 197-204.

McCracken, L. M. Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, longstanding chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335-1346.

Workshop 16

A Cognitive-Behavioural Parenting Intervention for Families of Young Anxious Children

Sam Cartwright-Hatton, University of Manchester and Deb McNally, Central Manchester and Manchester Children's NHS Trust

Anxiety is the most common psychological disorder of childhood, and is probably as common in young children as in older children and adolescents. Evidence based treatments for anxious children have been CBT based, and whilst this is useful for older children, it is less easy to use with their younger peers. Moreover, there is little direct evidence of the efficacy of CBT with younger anxious children. Research suggesting a role for parenting in the development of anxiety led us to develop a new parenting-based intervention for these clients. This workshop will present our 10-week cognitive behaviourally based intervention for the families of young sufferers of anxiety.

Key Learning Objectives

1 To present a new cognitive-behaviourally based intervention for families of young anxious children, including some basic theoretical background to the intervention.
2 To summarise the aims and objectives of the approach and give a general overview of the programme.
3 To illustrate key aspects of the programme using experiential exercises and role-play.
4 To provide attendees with some experiential practice at these techniques.

Objectives

1 By the end of the day, workshop attendees will have thought in some depth about the role of families in the etiology and maintenance of anxiety in childhood.
2 Workshop attendees will have a conceptual overview of the issues that they may need to consider in working with the families of anxious children.
3 Workshop participants will have learnt some new techniques for working with families of anxious children.

Sam Cartwright-Hatton is an academic clinical psychologist with a particular interest in the role of families in the development and treatment of anxiety in childhood. She holds an MRC Clinician Scientist Fellowship at the University of Manchester. Deb McNally is a clinical psychologist at Central Manchester and Manchester Children's Hospital's NHS Trust. She has a special interest in parenting, and runs parenting groups for families of children with anxiety difficulties, behavioural difficulties, and also families of children with cancer.

Key References

Cartwright-Hatton, S., McNally, D., White, C. (2005). A new cognitive behavioural parenting intervention for families of young anxious children: A pilot study. Behavioural and Cognitive Psychotherapy. 33, (2), 243-248.

Cartwright-Hatton, S., Roberts, C., Chitsabesan, P., Fothergill, C., & Harrington, R. (2004). Systematic Review of the Efficacy of Cognitive Behaviour Therapies for Childhood and Adolescent Anxiety Disorders. British Journal of Clinical Psychology. 43, 421-436.

Workshop 17

CBT for Traumatised Children and Young People

David Trickey, South London and Maudsley NHS Trust

Meiser-Stedman (2002) describes a cognitive model of PTSD for children. This framework will be used to consider PTSD in children and families, with particular reference to developmental and systemic aspects. Using this model, methods for intervening with various different parts of the systems in which traumatised young people find themselves will be presented and demonstrated, these include family work, working with schools and direct work with the young person. The evidence available indicates that exposure of some description is an important component of treatment for PTSD symptoms (Cohen et al . 2000). This means that clients generally need to 'remember', before they can 'forget'. The ethical and clinical dilemma of encouraging young people to do something that they do not want to do will be considered in the context of the inevitable power imbalance that exists between client and clinician. How can a clinician be persuasive without being coercive and respect a client's fears without colluding with them? This has important implications for how the rationale for treatment is explained to clients, and their fully informed consent is subsequently gained.

The mixed evidence concerning debriefing will be considered, and although debriefing per se is not recommended, alternative crisis interventions based on the cognitive model of reactions to trauma will be discussed.

Key Learning Objectives

• To understand how children and families react to trauma and how these reactions can be explained by the cognitive model
• To know how developmental and systemic factors impact on such a model
• To feel confident in offereing effective interventions to traumatised children and young people, including crisis interventions
• To know how to deal with ethical dilemmas of exposure-based treatments.

David is a Consultant Clinical Psychologist who worked for six years at the Traumatic Stress Clinic now at Great Ormond Street Hospital. He now works with community CAMHS at South London and Maudsley NHS; with an NHS child bereavement service where he specialises in traumatic bereavement and part-time as an independent Psychologist consulting to the police working with traumatised children or as an Expert Witness. He is often consulted at an early stage following trauma and asked to inform the crisis response. He regularly lectures on Doctorate Clinical Psychology Training Courses. He is also trained in Family Therapy and (EMDR).

Key References

Cohen, J. A., Berliner, L., & March, J. S. (2000) Treatment of children and adolescents. In E. B. Foa, T. M. Keane & M. J. Friedman. Effective treatments for PTSD: practice guidelines from the International Society for Traumatic Stress Studies (pp. 330-332). New York: Guilford Press.

Meiser-Stedman, R. (2002) Towards a Cognitive-Behavioral Model of PTSD in Children and Adolescents. Clinical Child & Family Psychology 5, 217-232.