Arnoud Arntz, University of Amsterdam

Imagery Rescripting: a method to process memories of traumatic and other negative experiences


Imagery Rescripting (ImRs) is an experiential method to process memories of traumatic events and other negative experiences that lie at the root of patients’ problems. In Imagery Rescripting patients imagine the original experience but alter the sequence of events so that their needs are better met. With very complex cases and early trauma’s, the focus is on memories from childhood and it is usually the therapist leading the Rescripting and intervening in fantasy to stop abuse, bring safety, and correct misconceptions about the experience, whilst the patient imagines being the child.  ImRs has found a wide range of applications, from PTSD, chronic depression and treatment-resistant anxiety and eating disorders to personality disorders. Moreover, it is the standard treatment of nightmares in the US. With patients suffering from visual intrusions the application is quite straightforward as the intrusions, or the memories that they are based on, can be directly addressed in Imagery Rescripting. However with other problems, like a negative self view or distrust in others, first memories of experiences that underlie such basic schemas need to be found. Usually the use of an ‘affect bridge’ between a recently experience of activation of the schema and a spontaneously early memory helps, and applications of this in a wide range of clinical problems have been found to be effective.  Imagery Rescripting has a number of attractive elements, including its broad and flexible range of application, its focus on changing the meaning of the experience, and the fact that it is not necessary to relive the whole trauma in all its details (which increases acceptability and usefulness for very severe cases). In this keynote the clinical effectiveness of ImRs will be discussed, as well as laboratory studies into basic mechanisms that underlie ImRs, indicating that ImRs indeed works thru meaning change.


Stephen Barton, Newcastle University

CBT for depression: it's time to integrate


Psychotherapy integration is usually between therapy schools such as cognitive-behavioural, systemic, interpersonal or cognitive-analytic.  This keynote argues for integration within the field of CBT.  CBT for depression is heterogeneous with multiple theories, models, evidence-bases and therapeutic approaches.  The past twenty years has seen a lot of diversification with the emergence of Behavioural Activation, Rumination-Focused CBT, Mindfulness-Based CT and other 3rd wave approaches, such as CFT and ACT.  These developments are welcome because depression is a multi-factorial problem:  clinical presentations are often wide-ranging, co-morbid and complex. Multiple approaches create more therapeutic possibilities. The field now has an embarrassment of riches but it lacks coherence.  Competition is inevitable but it tends to magnify differences, not unify them, and this can be confusing for front-line therapists.  For some years the Newcastle group has been developing an integrated model that harnesses the shared processes of cognitive and behavioural therapies.  It offers integration at theoretical, evidence-based and practical levels.  It’s not a new therapy; it’s a way of organizing current therapies to increase fidelity and respond to the needs of particular patients.  The approach is technically eclectic and uses cognitive science models (self-regulation, dynamic systems) to specify maintenance processes.  Empirical studies, practice-based evidence and a case illustration are used to introduce the approach.


Rachel Calam, University of Manchester

Working with parents to make a difference: from local to global and back again


The quality of parenting children experience plays a key role in their development. There is strong evidence indicating that high-quality, evidence based, theoretically driven parenting and family skills programmes can lead to significant improvements in the quality of parenting and family life that children experience. These interventions have the potential to prevent a wide range of difficulties, including emotional, behavioural and social problems, and national and international organisations recognise the potential of such approaches to prevent progress into long-term difficulties including mental health problems, substance misuse, violence and crime. In this presentation, new applications and developments in parenting and family skills programmes will be described, including work with families with parents with mental health difficulties, and international work with parents and families in very low resource settings and contexts of displacement due to armed conflict. Lessons learned in these contexts have relevance for work in a wide range of settings.


Barney Dunn, University of Exeter

Positive mood and wellbeing in depression


One of the cardinal symptoms of depression is anhedonia - a loss of interest and pleasure when engaging with pleasant activities. It is increasingly recognised that anhedonia is prognostically important and the failure to repair it is associated with poorer depression outcomes. Existing psychological therapies for depression have predominantly focused on reducing negative thinking and feeling and arguably have relatively neglected building positive thinking and feeling. This keynote will review basic science findings characterising the nature of anhedonia in depression, identifying which psychological mechanisms underpin it. Secondary analyses of randomised controlled trials evaluating how well CBT, Behavioural Activation and Anti-Depressant Medication repair anhedonia will also be presented. How this work has been translated into the development of a novel therapy approach targeting anhedonia will be outlined and preliminary findings of the feasibility, acceptability and efficacy of this therapy will be presented.


Peter J. de Jong, University of Groningen

The dirt road to psychopathology: Disgust-based mechanisms and their relevance for CBT


Disgust is a strong emotion that is characterized by negative appraisals, pervasive avoidance tendencies, and distinct autonomic defensive reflexes. Although disgust is typically conceptualized as an adaptive emotion, it can become highly dysfunctional when it is elicited by “the wrong” stimuli, when the threshold for experiencing disgust is (too) low, or when people experience feelings of disgust as being highly aversive. Until recently, disgust received only scant attention in clinical psychological science and has even been framed as “the forgotten emotion in psychopathology”. This situation is changing with a rapidly growing scientific interest in disgust as a relevant factor in mental disorders. This presentation will provide a concise review of this emerging research, illustrate how disgust-based mechanisms might contribute to the development of various disorders (e.g., phobias, OCD, PTSD, sexual dysfunctions), and address the potential implications for clinical interventions.


Colin Espie, University of Oxford

What is sleep … and why does it matter?


There is nothing that is more fundamental to behavioural, cognitive and emotional functioning than sleep. Like breathing, sleep is a largely involuntary behaviour that is essential to life, and it occurs unfailingly as part of an approximate 24-hour cycle across the lifespan. This presentation will summarise our current understanding of sleep and circadian processes, and how they relate to mental health. It will be argued that sleep is a primary function, rather than a secondary one, and that we should incorporate management of sleep and circadian processes into our treatment plans. Both scientific data and clinical illustration will be incorporated throughout the presentation.


Daniel Freeman, The University of Oxford

Persecutory delusions: understanding and treating excessive mistrust


Paranoia denotes the unfounded idea that others intend to cause you harm. Many people have a few paranoid thoughts, and a few have many. Persecutory delusions, seen in mental health services in the context of psychotic disorders, represent the severest form of paranoia. In this keynote talk, the development of a new translational treatment – the Feeling Safe Programme – will be described. The epidemiological research, theoretical framework, experimental studies, and clinical trials that underpin the Feeling Safe Programme will be outlined. The spirit, style, and content of this intervention will be explained. The overall ambition is for a step change in recovery rates for patients with severe paranoia.


Sarah Halligan, University of Bath

Child trauma and posttraumatic stress disorder: engaging with socio-contextual factors to understand (and change?) outcomes


Following traumatic experiences (e.g., physical or sexual assault, serious accidental injuries, natural disasters), young people are at risk of developing posttraumatic stress disorder and other adverse outcomes. For many young people exposed to trauma, psychological services are not available and they must rely on informal sources of support. This talk will consider the factors that influence child psychological adjustment posttrauma, with a focus on the role that families may play in determining outcomes. In addition to studies of relatively low risk UK samples, preliminary work in a high risk international setting will be described.


Emily Holmes, Karolinska Institutet, Sweden

Mental Imagery and Mental Health Science: From a Hospital to a Refugee Camp


Mental imagery involves an experience like perception in the absence of a percept, such as “seeing in our mind’s eye”. Intrusive, affect-laden mental images cause distress across mental disorders - Intrusive memories that “flash backwards” to past trauma occur in post-traumatic stress disorder (PTSD) while images that "flash forwards" to the future can occur in bipolar disorder.
My clinical research group has an interest in understanding and treating maladaptive mental imagery via psychological therapies. To do this, we are curious about what we can learn from cognitive psychology and neuroscience to inform treatment development. I will discuss recent work concerning intrusive memory encoding (Clark et al, 2016, Psych Med); disrupting memory re-consolidation via dual task interference to reduce the frequency of intrusive memories (James et al, 2015, Psych Sci); and impact of imagery in depression (Holmes, Blackwell, et al, 2016, Ann Rev Clin Psych:*). A broader vision for science-informed psychological treatment innovation will also be explored from working hospitals (Iyadurai et al, in press) to further afield with refugees (Holmes, Ghaderi et al, in press).
Website and publications:
* please see to get an origami model about imagery in depression


Nusrat Hussain, University of Manchester

Cultural Therapy for the Prevention of Self Harm: Turning the World Upside Down


Suicide is a major global public health challenge, every 40 seconds a person die of suicide. Suicide is among 3rd leading cause of death in 15-35 years old group.  According to the World Health Organization suicide rates have increased up to 60% in last 45 years and more than 70% of these suicide deaths are in low and middle income countries (LMICs). History of self harm increases the risk of suicide up to 100%.
To determine whether culturally adapted manual assisted problem-solving therapy (C-MAP) results in decreased suicidal ideation in patients with a history of self-harm. The study also explored the experience of self-harm in Pakistan and views about culturally adapted intervention.
A total of 221 participants recruited from public hospitals in Karachi were randomized into two study arms i.e., 12-week C-MAP intervention or treatment as usual (TAU) group (NCT01308151). Participants were assessed using Beck Depression Inventory, Beck Suicidal Ideation, Beck Hopelessness Inventory and EQ-5D.  In order to explore the experience of self harm, semi-structured in-depth interviews were conducted with 19 participants.
Patients in the C-MAP group showed statistically significant improvement on all outcome measures including health related quality of life. Framework analysis highlighted the role of difficulties in interpersonal relationships, domestic violence, isolation and poverty as factor associated with self harm. The brief psychological intervention was found to be feasible and acceptable in a low resource setting where self harm is an illegal act and is condemned socially and also religiously 
The WHO’s Mental Health Gap Action Program (mhGAP) for LMICs advocates delivery of evidence-based interventions to manage a number of priority conditions including suicide and self-harm. The results of the study have implications for addressing the huge mental health treatment gap across the globe.


Andrew Jahoda, University of Glasgow

The art of the possible: lessons and findings from an RCT comparing behavioural activation  for depression in adults with learning disabilities with guided self-help


The art of the possible: lessons and findings from an RCT comparing behavioural activation  for depression in adults with learning disabilities with guided self-help


Steve Kellet, University of Sheffield

10 years of IAPT - an overview of clinical and organisational lessons learnt


As a provider of PWP and High Intensity training since 2008 and also part of the Yorkshire and Humber IAPT Practice Research Network (PRN), this talk will identify and reflect on the key challenges, achievements and continuing issues with the IAPT programme from clinician, educator and researcher perspectives.  The talk will showcase the teaching and curriculum innovations developed by the teaching teams and highlight the key publications from the PRN to develop a narrative overview of the 10 years.  The talk will also share some key insights into (a) the defining features of more and less competent CBT therapists, (b) how to develop and maintain effective collaborations between educators and clinical services and (c) how to put practitioners at the heart of evaluation efforts.     


Colin MacLeod, The University of Western Australia

Anxiety-linked Attentional Bias and its Modification: Critical Reflections and New Directions


It is well-established that both elevated dispositional anxiety and clinical anxiety dysfunction are characterised by an attentional bias that operates to favour the processing of threatening information. Compelling evidence that this attentional bias causally contributes both to heighted anxiety vulnerability and to clinical pathology has been provided by studies showing that the successful modification of the attentional bias serves to reduce anxiety reactivity to stressors, and to attenuate dysfunctional symptoms associated with anxiety disorders. Nevertheless, recent years have witnessed debate and disagreement over a number of important issues concerning anxiety-linked attentional bias and its modification, including the nature of the attentional mechanisms that underpin the observed patterns of processing selectivity, the adequacy of the assessment procedures most commonly used to measure this attentional bias, and the therapeutic value of directly modifying attentional bias to threat in enhancing emotional resilience and treating anxiety disorders. This presentation will reflect on these contentious issues to i. convey the nature of the debates that have arisen; ii., highlight some misconceptions that have the potential to drive ongoing misunderstanding; and iii. illustrate some of the new directions our own research into anxiety-linked attentional bias and its modification has recently taken, in response to these various issues.  


Lars-Göran Öst, Stockholm University, Sweden

Brief, intensive, and concentrated CBT for anxiety disorders


Anxiety disorders are among the most common mental disorders with a lifetime prevalence of 12.5%. Cognitive-behavior therapies (CBT) varying between 8-15 sessions in length, are evidence-based for the treatment of anxiety disorders in both adults and youth. During the last two decades treatments that are brief, intensive, or concentrated (BIC) have been developed and this meta-analysis includes 87 RCTs across the anxiety disorders. There are 36 brief, 44 intensive, and 7 concentrated treatments. BIC yielded a lower attrition (2.1%) than standard CBT (6.1%). The effect sizes (ES) for comparison of BIC with waiting-list (1.39 and 1.47) and placebo (0.87 and 0.82) were significant, whereas the comparison with standard CBT (0.03 and 0.07) for adult and youth studies, respectively, was not. In adult studies remission at post/recovery at follow-up was 73%/75% for BIC and 74%/73% for standard CBT. In youth studies the corresponding rates were 54%/64% for BIC and 57%/63% for standard CBT. Within-group ES at post and follow-up were 1.90 and 1.93 for BIC, and 1.96 and 1.87 for standard CBT, indicating maintenance of the effects up to 12 months after therapy. Advantages and disadvantages of BIC are discussed and it is suggested that BIC-interventions represent a paradigm shift in the delivery of services for patients with anxiety disorders.


Kate Rimes, King's College London

Chronic fatigue syndrome: Emotional processing and stress vulnerability


Chronic fatigue syndrome (CFS, also known as ‘ME’) is characterised by severe and disabling physical and mental fatigue that occurs for most of the day and has lasted at least six months. A range of other symptoms are typically present, such as muscle or joint pain, headaches, concentration difficulties and sleeping problems.  It is often triggered by a virus or adverse life event. Multiple factors are likely to be involved in the maintenance of symptoms and these will vary across individuals. This talk will focus on two related areas that have been investigated in relation to chronic fatigue syndrome. Research investigating emotion processing and stress reactivity in people with CFS / ME will be described and treatment implications discussed.


Roz Shafran, University College London, Great Ormond Street Institute of Child Health

CBT for Clinical Perfectionism: The good, the bad and the reality


Perfectionism can be dysfunctional in a number of ways. First it can be present a significant clinical problem in its own right that interferes with functioning. Second, it can interfere with successful treatment of Axis I disorders. Third, it is a risk factor for the development of psychopathology. The first part of the keynote will present an overview of the current cognitive-behavioural approach to the understanding and treatment of perfectionism including results from the first meta-analysis indicating that it can be successfully addressed. Findings from different modes of delivery will also be presented and lessons learned from mistakes will be embraced. The second part of the keynote will describe top tips for treatment. The presentation will conclude with suggestions for future directions for the development of research and therapy for perfectionism.


Ed Watkins, University of Exeter

Understanding and Enhancing Treatment and Prevention of Depression


Depression is a major global health challenge and amongst the leading causes of disability. Moreover, there is a major treatment gap: our best treatments achieve remission rates less than 1/3 and limited sustained recovery, and traditional models of psychotherapy treatment cannot reach sufficient numbers to tackle the global burden. We thus need more scalable and efficacious interventions, including prevention of depression. I will review third interleaved approaches to enhance the treatment and prevention of depression. First, understanding and targeting key psychopathological mechanisms implicated in the onset and maintenance of depression a potential way to improve the effectiveness and efficacy of treatment and prevention, using the example of rumination. Rumination contributes to the maintenance and onset of depression and anxiety, acts as a final common pathway for multiple vulnerabilities, and is identified as a transdiagnostic mechanism (Nolen-Hoeksema & Watkins, 2011). Basic research suggests that rumination can be usefully conceived as a mental habit (Watkins & Nolen-Hoeksema; 2014; Hertel, 2004) with an abstract decontextualized thinking style implicated in its negative consequences (Watkins, 2008).  Adaptations of CBT targeting rumination are efficacious for difficult-to-treat residual depression (Watkins et al., 2010), outperforms standard CBT in treating major depression (Hvennegard et al., submitted) and prevents anxiety and depression in high risk young adults (Topper et al., 2017).  Second, underpinning the efficacy gap is limited understanding of how complex psychological interventions for depression work (Holmes et al., 2014). To address this, a second approach is to conduct experimental research to better understand the active ingredients of therapy, which I illustrate through a large-scale factorial trial of internet CBT. A third approach is to utilise non-traditional approaches to tackle depression including through information technology and lifestyle change, including change in the nutrition (the MooDFOOD project).