In-Conference Workshop Presenters and Topics.

The In-Conference Workshops will take place on Thursday 21 June and Friday22 June 2001. The cost is £20 each for delegates.

Thursday 21st June 14:00 - 16:45


1. What To Do When Difficulties Arise While Treating Victims of Violence With Imagery-Based Cognitive Interventions- Mervin R. Smucker, Medical College of Wisconsin, USA

This workshop is of an Intermediate/Advanced level and will focus on how to trouble-shoot when the therapist encounters problems while attempting to implement imagery-based cognitive-behavioural interventions, especially pertaining to the treatment of PTSD. Problematic case examples will be addressed and explored. Workshop participants are invited to bring difficult case material to the workshop for discussion. The workshop format will include video demonstration, case examples, role-plays, and participant discussion.

Recommended Readings:
Smucker, M. R., & Dancu, C.V. (1999). Cognitive Behavioral Treatment for Adult Survivors of Childhood Trauma: Imagery Rescripting and Reprocessing. Northvale, NJ: Jason Aronson.
Smucker, M. R., Dancu, C., Foa, E.B., & Niederee, J. (1995). Imagery Rescripting: A new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress. Journal of Cognitive Psychotherapy: An International Quarterly, 9(1), 3-17.
Smucker, M. R., & Niederee, J. (1995). Treating incest-related PTSD and pathogenic schemas through imaginal exposure and rescripting. Cognitive and Behavioral Practice, 2, 63-93.

2. CBT for Chronic Fatigue Syndrome - Jill Roberts & Christina Surawy, John Radcliffe Hospital, Oxford

Chronic Fatigue Syndrome (CFS) is a debilitating and frustrating condition. Often this group of clients can be seen as difficult to help. We work in a specialist service offering cognitive behaviour therapy to people with CFS. The workshop will offer an overview of our treatment approach. We will aim to share our knowledge of working in a cognitive behavioural way with patients diagnosed as having CFS. We will draw particular attention to working within the context of a formulation based on theory, and we will demonstrate what we do through role play and discussion and the use of video demonstration.

Learning Objectives:
· Have a greater knowledge of how CFS can be understood within a cognitive framework
· Be aware of particular issues which arise in the treatment of this population
· Understand and have some experience of how the formulation can guide treatment

Key References:
Surawy, C., Hackmann, A., Hawton, K., Sharpe, M. Chronic fatigue syndrome: a cognitive approach. Beh. Res. Ther. (1995), 33:535-544.
Report of a joint working group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners (1996).
Chronic Fatigue Syndrome (CFS/ME): The Facts by Frankie Campling and Mike Sharpe. OUP 2000.

3. Assessment And Treatment Of Body Dysmorphic Disorder - Scott M. Granet, Palo Alto Medical Foundation, USA

As much as 1-2% of the general population is believed to be suffering from Body Dysmorphic Disorder, yet few therapists have much experience with treating it. True numbers, however, are difficult to assess as the tremendous shame associated with BDD frequently keeps patients from seeking treatment. Although classified in the DSM-IV as a somatoform disorder, BDD is believed to be quite similar to obsessive-compulsive disorder, and is generally included as part of the obsessive-compulsive spectrum. Characterized by tormenting obsessive thoughts concerning appearance, and related compulsive behaviors, BDD is often mistaken as vanity, though clearly can become a very serious psychiatric problem. Those who suffer from it believe that a part of their physical appearance, such as muscle tone, eyes, nose, teeth, hair, height, weight, and bone density are deformed in some way, yet such deformities are barely, if at all, noticeable to others. Many will, in fact, become delusional at times, and see a deformity that just doesn't exist. Any part of one's physical appearance may become the focus of BDD, and people often have more than one body part identified. BDD sufferers engage in many behaviors to try and cope with the disorder, though typically these behaviors only worsen it. Examples include checking behaviors, such as with mirrors or other reflective surfaces, touching the body part, as well as frequent reassurance seeking. Excessive grooming, comparing the body part to that of others, and camouflaging the "defect" through such means as the overuse use of make-up, and wearing baggy clothes, are also common behaviors associated with the disorder. Other problematic activity may include seeking unnecessary medical appointments and procedures in an attempt to correct the "defect", as well as self-destructive behavior such as skin picking.
Body Dysmorphic Disorder rarely exists without the presence of other disorders. The most common include major depression, social phobia, and substance abuse. Suicide is also a factor, as some with the disorder have taken their own lives to end the suffering BDD can create. Other problems also tend to accompany BDD, such as social isolation, relationship problems, and occupational and academic stress. It is not uncommon to encounter BDD sufferers who have experienced numerous failed relationships, dropped out of school, or stopped working due to the troublesome symptoms, which may permeate someone's life.
Unfortunately, many people with BDD first seek medical consultation to address their concerns, and often do not seek psychiatric care until significant life problems develop. Even then, however, these individuals are often misdiagnosed, and as such are not given the proper treatment. It is important to appreciate, however, that effective treatment does exist in the form of medication, and cognitive-behavioral therapy. This workshop will highlight the latest such information available, while also thoroughly reviewing epidemiology, and clinical features.

Learning objectives
· Define body dysmorphic disorder, and review major research on the subject.
· Review reasons for BDD being considered as an obsessive-compulsive spectrum disorder.
· Review likely causes of the disorder, including biochemical, psychological, and sociocultural factors.
· Identify cognitive and behavioral manifestations of the disorder.
· Identify disorders often comorbid with BDD.
· Review tools for assessment of the disorder.
· Explore treatment strategies, including medications, and cognitive-behavioral therapy.
· Describe the most common functional impairments of those who suffer from the disorder.
· Discuss the value of utilizing group treatment.
· Note international support resources available to sufferers, and concerned others.

Friday 22nd June: 9.00 - 11:45

4. CBT With Children- What Part Should Parents Play? Peter Fuggle, Camden and Islington NHS Trust & Miranda Wolpert, Bedfordshire and Luton NHS Trust

This workshop draws on our own experience of developing CBT practice with children in generic community child mental health services within the NHS, and the particular issues that we have found this raises for successful implementation of this approach. In particular, we have come to believe that establishing an effective framework of work with the parent(s) is crucial to successful treatment outcome, and that determining how this can best be achieved raises a number of interesting challenges and choices for the clinician that have a major impact on the way the work is conceived and carried out.

CBT is increasingly seen as an effective treatment for a range of difficulties that children present with in child mental health setting. Much of the literature on how to carry out CBT is still very much focused on individual work with a child and does not consider the treatment of the child in the context of his/her family. Our experience indicates that there are important choices that need to be made as to how the therapy will be structured in relation to the parent, and that in making these choices it may be helpful to draw on ideas from narrative and family therapy and also to be sensitive to changes in practice that are likely to be brought about by the application of Human Rights Legislation and an ever increasing emphasis on user involvement.

This workshop will present some preliminary ideas of conceptualising different types of parental contributions to effective practice in the light of these issues. We will outline the existing models of parental involvement implicit in the literature and go on to suggest a framework for making choices about how parents may be thought of in relation to this work. In particular we will argue that a parent can be most usefully conceived of as falling into one of the following categories: patient, customer, assistant therapist, or non-participant. Case examples of parents in each of these roles will be presented and the rationale behind different treatment decisions will be explored. The workshop will provide opportunities for participants to share their own case examples and these will be used to further develop general principles of good practice with respect to collaborative treatment planning and innovative interventions with children and parents.

Learning Objectives:
· Participants will be offered a conceptual model to guide them in their work with parents and principles of good practice in this area will be elaborated.

Key References
Carr, A. (1999) The Handbook of Child and Adolescent Clinical Psychology. A Contextual Approach (Routledge, London)
March, J.S. & Mulle, K.M. (1998) OCD in Children and Adolescents. A Cognitive-Behavioural Treatment Manual (Guildford Press)
White, M. & Epston, D. (1990) Narrative means to Therapeutic Ends (New York: Norton)


Children And ADHD, Alternatives To Amphetamines

In memory of Professor Steve Baldwin with contributions from colleagues and friends.

Discussant: Shona Mclntosh, Lothian Primary Care NHS Trust.
Speakers: Arlene Vettere, University of Reading, Emmeline Froebe, University of Teeside, Ken Altken, SIGN Guidelines Committee, Janice Hill, The Overload NetWork.

ADHD is the most frequently diagnosed disorder of childhood (Kazdin 1999), Despite 100 years of clinical investigation and research there are few outright solutions to the problems of hyperactivity and impulsivity in children. Practitioners in the field need a clear direction with the provision of proven effective treatment. This workshop aims to provide practitioners with at least two effective alternatives to amphetamine therapy for children/teenagers with ADHD, Workshop participants are encouraged to plan and provide more ideal solutions to ADHD in their own locality,

The workshop will include reviews of effectiveness of chemical treatments for ADHD; the MTA study, Patterson's social learning approach (1971) and Stein's Caregiver Skills Program (1999).

5 'Stress Control' - a didactic CBT group approach for the emotional disorders - Jim White, Clydebank Health Centre

The aim of this workshop is to describe a didactic, cognitive-behavioural group therapy approach to the emotional disorders and to teach how to run such courses. 'Stress Control' is a robust six session 'evening class' designed for either small or large group format - anything between 6 and 60 on each course. It is designed to be flexible to better meet the needs of routine clinical work. The therapy has, as its basic premise, the goal of 'turning individuals into their own therapists'. It differs fundamentally from much therapy in that the role of the therapist becomes that of the teacher while the patient becomes the student. Reconceptualising roles in this way helps the individual to take responsibility for change and to attribute change to the individual's own coping skills rather than to the skill of the therapist. The 'ban' on discussing personal information helps attract those individuals, especially men, who do not want to take part in disclosure group work. It is mainly used as a 'complete' therapy but can be used adjunctively with individual therapy. It is designed for the treatment of heterogeneous anxiety disorders and mixed anxiety/depression and assumes the presence of comorbid problems. CBT strategies are taught for generalised anxiety, panic, depression and insomnia. The course attempts to teach individuals to understand their problems within both a psychological and social context.

The approach is clinically effective and efficient and has been empirically tested with representative patients. It attempts, within a 'scientist-practitioner' framework, to achieve the best compromise between best practice and best value in providing help to a large number of people. It relies heavily on the written material that accompanies the course. Course topics can be varied according to the composition of the group.

No previous experience of group treatment is necessary although some knowledge of CBT would be helpful. This practical workshop will look at such issues as setting up the course, deciding who should attend and how to run each session.

Friday 22nd June 14:00 - 16:45

6. Body Image in Children: Development, Distortion, Dissatisfaction, and Deviance - Rick M. Gardner, University of Colorado, Denver, USA

Body image disturbance is part of the core psychopathology of anorexia nervosa and bulimia nervosa. Despite its clinical importance to these and other disorders (such as Body Dysmorphic Disorder), the concept is poorly understood. Part of the reason for this may be the theoretical, conceptual and methodological confusion that has plagued much of the clinical literature.

In recent years, however, detailed studies of the development of normal and abnormal body image in children have helped to improve our understanding of the concept and how to assess it. In this mini-workshop, we will cover several aspects of body image development and disturbance in children and young adolescents. The affective and perceptual components of body image will be discussed. Measurement techniques will be reviewed, including the use of figural stimuli, subjective and attitudinal measures, and perceptual measures. Attendees will receive copies of several contemporary scales used in measuring body size and dissatisfaction in children and adolescents. Important methodological issues in measuring body image will be discussed. Findings from the presenter's research on predictors of eating disorder scores in children aged 6 through 14 will be described. In addition, findings on the role of media influences will be discussed.

Learning Objectives
Understand the different components of body image
Learn state-of-the-art assessment techniques to measure body image and its disturbance
Discover the latest research findings on the development of body image and its disturbance in children and adolescents

Key references
Gardner, R. M., Stark, K., Friedman, B.N., & Jackson, N. A. (2000). Predictors of eating disorder scores in children ages 6 through 14: a longitudinal study. J Psychosom Res. Sep;49(3):199-205.
Gardner, R. M., Stark, K., Jackson, N. A., & Friedman, B.N. (1999). Development and validation of two new scales for assessment of body-image. Percept Mot Skills. Dec;89(3 Pt 1):981-93.
Gardner, R. M. (1996). Methodological issues in assessment of the perceptual component of body image disturbance. Br J Psychol., 87 ( Pt 2):327-37.

7. The nature and treatment of anxiety disorders in children and adolescents - Ronald M. Rapee, Macquarie University, Sydney, Australia.

For some years we have been conducting a treatment program for anxious children and adolescents at Macquarie University. Treatment is conducted over approximately 9 sessions and both parents and children attend all sessions. The treatment components include education, cognitive restructuring, parent management strategies, approach to feared situations, and rewards. Data from this and similar programs indicate a high degree of success with most children showing moderate to marked change and results maintaining for up to 6 years. The workshop is ideal for anyone working clinically with anxious children and adolescents. This includes practising clinical psychologists and other mental health workers, educators, and school counsellors.

Learning Objectives:

· Identify and diagnose anxiety disorders in children and adolescents
· Have a broad appreciation for the psychopathology of child anxiety disorders
· Have a detailed understanding of a treatment program for the management of child anxiety.

Key References
Rapee, R.M., Spence, S.H., Cobham, V., & Wignall, A. (2000). Helping your anxious child: A step by step guide for parents. New Harbinger.
Rapee, R.M., Wignall, A., Hudson, J.L., & Schniering, C.A. (2000). Treating anxious children and adolescents: An evidence-based approach. California: New Harbinger.
Rapee, R.M. (2000). Group treatment of children with anxiety disorders: Outcome and predictors of treatment response. Australian Journal of Psychology, 52, 125-130.

8. Supervision Moving beyond the mere Transmission of CBT Techniques
Claudia Herbert (Oxford)

Therapists working with Cognitive Behavioural Treatment Approaches are increasingly required to be able to work with clients with long-standing and severe psychological problems, for example, multiple traumas and arising out of these, Personality Disorders, including Borderline Personality. The needs of today's clients are often complex and in order for Cognitive Behavioural Therapists to be effective with their clients, therapeutic approaches need to be tailored to each client's individual problem presentation and therapeutic work needs to be longer-term, requires an exploration of both past and present issues and needs to include an understanding of the therapeutic relationship, which can be relentlessly tested because of clients'interpersonal difficulties (Persons & Bertagnolli, 1994). Therapeutic work of this complexity can pose a number of problems for the therapist, including feeling overwhelmed, incompetent or abused by the client, and can leave CBT therapists feeling very challenged. Repeated, long-term work with clients suffering from trauma can even lead to changes in the therapist and can damage, unsettle or throw therapists off their chosen path (Herbert & Wetmore, 1999). In order to be effective and survive and maintain work in this area over longer periods of time, therapists need clinical supervision that moves beyond the mere transmission of CBT Techniques. Instead, clinical supervision needs to include not only an awareness of the complexity of the issues involved in this type of work for the therapist, but the successful mastery of a process between supervisor and supervisee, that parallels therapy itself (Padesky, 1996). Beyond the transmission of CBT techniques, effective supervision needs to also entail a focus on the underlying therapeutic processes and the resulting issues arising in the therapist-client relationship. This would include enabling therapists to form an awareness of their own cognitions and schema-processes, as these become activated in the course of their therapeutic work and affect their ways of working with clients.

The learning objectives for this workshop are:To theoretically explore the current requirements of therapist competency for working with complex client presentations using a Cognitive Behavioural Approach; To define the ingredients needed for effective supervision of CBT therapists working with complex client cases; For supervisors to review their current supervisory practice and to identify areas for development and change

Recommended Reading
Herbert, C. & Wetmore, A. (1999) Overcoming Traumatic Stress, A self-help guide using Cognitive Behavioural Techniques. Robinson Publishing Ltd, London.
Kolb, D.A. (1984) Experiential Learning. Prentice Hall, London.
Padesky, C. (1996) Developing Cognitive Therapist Competency: Teaching and Supervision Models. In Salkovskis, P.M. (Ed) Frontiers of Cognitive Therapy. Guilford Press, New York.
Persons, J. & Bertagnolli, G. (1994) - CBT of multiple-problem patients: application to personality disorder. Clinical Psychology and Psychotherapy, 1, 277