Choose from 12 Pre-Conference Workshops
Surprising New Developments in CBT for Obsessions and Compulsions
David A Clark, University of New Brunswick, Canada
For 50+ years exposure and response prevention (ERP) has been the gold standard psychological treatment for obsessive compulsive disorder (OCD). Much progress has been made in our understanding of the cognitive basis of obsessions and compulsions, and yet treatment advances have not kept pace. Meta-analyses of outcome studies indicate that effect sizes for OCD have not improved appreciably with the advent of cognitive and “third wave” interventions. And yet, only 60% of individuals with OCD show a significant treatment response to standard ERP and a mere 25% achieve symptom-free status. This workshop presents the latest developments in cognitive-behavioral theory and treatment, with special focus on obsessions. In the last decade new concepts and processes have been discovered that can enhance treatment of OCD symptoms that do not respond well to standard ERP. Workshop topics addressed include (a) an introduction to the CBT model of OCD and its subtypes, (b) dealing with disorder-specific ruptures in the therapeutic relationship, (c) developing an individualized cognitive case formulation, (d) strengthening patient commitment to CBT treatment, (e) maximizing homework compliance, and (f) utilizing specific cognitive and behavioral intervention strategies to address the biased cognitive processes responsible for the persistence of the disorder. These topics are understood within a conceptual framework that integrates the generic cognitive appraisal and inhibitory learning models of OCD.
The workshop attendee will learn how to incorporate new symptom-subtype concepts and processes into a cognitive behavioural assessment, case conceptualization and treatment of specific types of obsessions and compulsions like mental contamination, pathological doubt, repugnant obsessions, and order/symmetry compulsions
Key learning objectives:
- To increase knowledge of the most recent advances in the CBT model of OCD and its subtypes.
- To identify, assess and counter the specific OCD-related threats to the working alliance.
- To develop individualized symptom-subtype cognitive case formulations.
- To strengthen patient acceptance of the treatment rationale as well as homework compliance through active psychoeducation exercises.
- To integrate cognitive intervention strategies with standard ERP to target specific cognitive beliefs and biases.
- To transform ERP into empirical hypothesis-testing and inhibitory learning experiences.
David A. Clark, PhD, is Professor Emeritus, Department of Psychology, University of New Brunswick, Canada and a practicing clinical psychologist with 30+ years in providing cognitive behavioural treatment for OCD. He received his PhD from the Institute of Psychiatry is a Fellow of the Canadian Psychological Association, Founding Fellow/Trainer Consultant of the Academy of Cognitive Therapy, and ad hoc consultant with the Beck Institute. He was a founding member of the Obsessive Compulsive Cognitions Working Group, and recipient of the Aaron T. Beck Award in 2008. He has co-authored several publications with Prof. Beck including Cognitive Therapy for Anxiety Disorders (Guilford, 2010), and The Anxiety and Worry Workbook (Guilford, 2012). He is sole author of The Mood Repair Toolkit (Guilford, 2014) and Controlling Your Mind: A Workbook for Depression, Anxiety and Obsessions (Robinson, 2018). A comprehensive revision his 2004 OCD clinician handbook is scheduled for release in November, 2019 and retitled Cognitive-Behavioral Therapy for OCD and Its Subtypes (Guilford Press).
Clark, D. A. (2018) Controlling Your Mind: A Workbook for Depression, Anxiety and Obsessions. London: Robinson.
Jacoby, R. J., & Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder. Clinical Psychology Review, 49, 28-40.
Rachman, S., Coughtrey, A., Shafran, R. & Radomsky, A. (2015). Oxford Guide to the Treatment of Mental Contamination. Oxford: Oxford University Press.
Adapting Cognitive Behavioural Interventions for Autism
Ailsa Russell, University of Bath
Autistic people are disproportionately affected by mental health problems, particularly anxiety and depression. Cognitive behavioural interventions have been found to be effective in treating co-occurring mental health problems if adapted to meet the needs of autistic people. This workshop will provide an introduction to Autism and the rationale for adapting CBT. The main adaptations to assessment, formulation and intervention will be presented. Practice exercises will be used to bring the principles to life. The focus will be cognitive behavioural practice with autistic people 14 years and older who do not have an intellectual disability.
This workshop aims to improve therapist knowledge about and confidence in working with autistic people. The intended learning outcomes may also be helpful in adapting practice for people with social communication difficulties who do not have a formal diagnosis.
Key learning objectives:
- To become familiar with the key adaptations to CBT for mental health problems in the context of Autism
- To understand the rationale for the adaptations to CBT
- To gain classroom-based skills practice in the key adaptations
- To become familiar with the evidence base
Dr Ailsa Russell is a Reader in Clinical Psychology at the University of Bath. She has worked in national specialist and adult autism services and community based adult autism services. She has led on two clinical trials investigating the usefulness of adapted CBT for co-occurring mental health problems, specifically treating Obsessive Compulsive Disorder (OCD) and Depression.
Hollocks MJ, Lerh JW, Magiati I, Meiser-Stedman R, Brugha TS. Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological medicine. 2018 Jul 25:1-4.
Anderson, S. & Morris, J. (2006) Cognitive Behaviour Therapy for people with Aspergers Syndrome Behavioural and Cognitive Psychotherapy 34(3):293-303
Cooper, K., Loades, M.E. and Russell, A. (2018) Adapting psychological therapies for Autism Research in Autism Spectrum Disorders 45; 43-50
Russell, A.J., Jassi, A. and Johnston, K. (2019) OCD and Autism: A clinician’s guide to adapting CBT Jessica Kingsley Publishers: London
Feedback-informed treatment: an evidence-based method to identify and resolve obstacles to effective CBT
Jaime Delgadillo, University of Sheffield
CBT is effective for the treatment of depression and anxiety problems; however, it is also known that at least 30% of patients do not show reliable improvement and some deteriorate. Recent studies have demonstrated that it is possible to improve the efficiency and effectiveness of CBT using feedback-informed treatment (Delgadillo et al., 2017, 2018; Janse et al. 2017), which combines routine outcome monitoring with individualized case formulation and trouble-shooting skills. Feedback-informed treatment bridges between nomothetic and idiographic approaches to assessment and formulation: it uses insights from clinical population data to understand possible obstacles that might be relevant to individual patients. In this way, therapists are able to identify and resolve problems in a timely manner, adjusting protocol-driven treatments when necessary.
This workshop will focus on the integration of routine outcome monitoring, case formulation, and clinical trouble-shooting skills in CBT. Participants will learn about the current evidence-base on predictors of treatment outcomes and will also consider practical skills on how to (a) identify, (b) formulate and (c) address obstacles to improvement. The feedback-informed treatment model covered in this workshop has been empirically tested in a large multi-site randomised controlled trial (Delgadillo et al., 2018).
The workshop will equip participants with practical guidelines on how to combine routine outcome monitoring and clinical case formulation to improve CBT outcomes.
Key learning objectives:
Participants will learn about:
- The current evidence base on feedback-informed treatment.
- How to successfully integrate routine outcome monitoring and prognostic methods in CBT practice.
- How to identify, formulate and address common obstacles to improvement.
Jaime Delgadillo is a Lecturer in Clinical Psychology at the University of Sheffield and a CBT therapist in RDASH NHS Foundation Trust. His research focuses on outcome measurement, prediction and feedback. He has led the development and implementation of personalised care technologies in NHS psychological services.
Delgadillo, J., Overend, K., Lucock, M., Groom, M., Kirby, N., McMillan, D., Gilbody, S., Lutz, W., Rubel, J.A., and de Jong, K. (2017). Improving the efficiency of psychological treatment using outcome feedback technology. Behaviour Research and Therapy, 99, 89-97.
Delgadillo, J., de Jong, K., Lucock, M., Lutz, W., Rubel, J., Gilbody, S., Ali, S., Aguirre, E., Appleton, M., Nevin, J. and O'Hayon, H. (2018). Feedback-informed treatment versus usual psychological treatment for depression and anxiety: a multisite, open-label, cluster randomised controlled trial. The Lancet Psychiatry, 5(7), 564-572.
Janse, P. D., De Jong, K., Van Dijk, M. K., Hutschemaekers, G. J., & Verbraak, M. J.(2017). Improving the efficiency of cognitive-behavioural therapy by using formal client feedback. Psychotherapy Research, 27(5), 525–538.
Working with complex issues in psychosis: suicidality, violence and substance misuse
Gillian Haddock, University of Manchester
Maximising your effectiveness as a CBT therapist: helping your client get the most out of each session that you provide
Abi Bradbury, Denis Convery, Jen Hague, Stephen Kellett, Catherine Machin and Alison Pickard, University of Sheffield
This workshop will bring together various streams of research concerning delivery of CBT including the notion of treatment integrity (i.e. the combination of treatment fidelity and treatment competency), the defining features of effective therapists (i.e. therapist effects and particularly the role of the therapist’s personality), therapeutic drift, use of supervision, resilience, reflection in and on action and self-compassion/compassion fatigue.
This workshop is designed for therapists who work with a high volume of often complex patients – also that may also not be that suitable for CBT at times. The aim of the workshop is to support therapists in their difficult and challenging roles by focussing on the factors, in particular, that have plasticity and are therefore potential mechanisms of personal and clinical change. The everyday clinical practice of attendees should be nourished and changed by attendance, as the workshop will focus on enabling therapists to maximise their helpfulness by focussing (and having equipoise) between what the therapist brings to therapy, their organisational context, the therapeutic relationship and the CBT model itself.
Key learning objectives:
- To be more aware of what disables personal therapeutic effectiveness
- To be more aware of enables personal therapeutic effectiveness
- To be better able to articulate an effective model of self-care and resilience to achieve more consistency of outcomes across patients
- To have greater personal insight into the personal style that informs your personal delivery of CBT.
The workshop leaders are all experienced therapists, trainers and supervisors at the University of Sheffield IAPT High Intensity Course.
Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work (2nd ed.). New York: Oxford University Press.
Waller, G. and Turner, H. (2016) Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behaviour Research and Therapy, 77, 129-137.
Susan Bogels, University of Amsterdam, Center for Mindfulness the Netherlands
Despite its inherent joys, the challenges of parenting can produce considerable stress. These challenges multiply- and the quality of parenting may suffer- when a parent or child has mental health issues, or when parents are in conflict. Even under optimal circumstances, the constant changes as children develop can tax parents' inner resources, often undoing the best intentions and parenting courses.
Mindful Parenting (Bögels & Restifo, 2014) is an eight-week structured mindfulness training program, based on MBSR and MBCT. It is designed for use in mental health care contexts, for parents who have mental health problems that interfere with parenting, or whose children have mental health problems. The program's eight sessions focus on mindfulness-oriented skills for parents, such as parenting with beginner’s mind, awareness and acceptance of strong emotions in parent and child, mindfully responding to (as opposed to reacting to) parenting stress, fostering compassion., and taking care of ones inner child The program is now also adapted for other settings such as prevention.
In this workshop the theoretic underpinnings of Mindful Parenting (Bögels et al., 2010), the rationale, and the build-up of the program, are outlined, and demonstrated with several imaginary and meditation practices that participants can experience. Video-examples are also shown. Results of Mindful Parenting in a mental health care context on outcomes such as parental and child psychopathology, parenting stress, and parenting, are presented, and mediating mechanisms, such as general mindfulness, mindful parenting, and parental experiential avoidance, are discussed. Furthermore, results of Mindful Parenting in a preventive context is reviewed.
Mindful parenting can be used while guiding parents with children with mental disorders, but is also relevant as a general attitude for professionals working with clients.
Key learning objectives:
- Insight in theories, working mechanisms and effects of mindful parenting
- Overview of the 8-week mindful parenting program
- Experiencing the key practices of mindful parenting
- Assessment of parent and child effects
Prof. Dr. Susan Bögels is a clinical psychologist and psychotherapist, specialized in Cognitive Behaviour Therapy and mindfulness training for children and their families. She works as professor in family mental health at the University of Amsterdam and as a mindfulness trainer and teacher trainer at the Center for Mindfulness in Amsterdam.
Bögels, S., & Restifo, K. (2013). Mindful parenting: A guide for mental health practitioners. Springer or Norton.
Bögels, S. M., Hellemans, J., van Deursen, S., Römer, M., & van der Meulen, R. (2014). Mindful parenting in mental health care: effects on parental and child psychopathology, parental stress, parenting, coparenting, and marital functioning. Mindfulness, 5(5), 536-551.
How to Teach DBT Skills to Adults and Young People
Catherine Parker and Marie Wassberg, Derbyshire Healthcare NHS Foundation Trust
Treating PTSD in Survivors of Domestic Violence
Pippa Stallworthy, South West London and St George's Mental Health Trust
Providing Help at the Point of Need: CBT-oriented Single-Session and One-at-a-Time Therapies
Windy Dryden, Goldsmiths University of London
Introduction to Mindfulness-integrated Cognitive Behaviour Therapy
Alice Shires, University of Technology Sydney, Australia
Supervision for CBT therapist
Sarah Rakovshik, University of Oxford
Therapist Drift: Why therapists do dumb things (and how to do fewer of them)
Glenn Waller, University of Sheffield