KEYNOTE SPEAKERS - 'Extending the application of CBT'

Friday 7th April

Empirically grounded strategies for improving mental health in the context of general medical presentations

Paul Salkovskis, University of Bath


Anxiety focussed on health is a frequent issue in those seeking help in general medical settings. CBT for health anxiety has been shown to be effective, can be disseminated and generalises across settings. It has been know for some time that this approach can be applied to Medically Unexplained Symptoms (MUS) and there is now evidence of its relevance to the psychological complications of Long Term Medical Conditions (LTC), alongside other co-existing mental health problems. Those suffering from these type of problems tend to incur significantly higher health costs than the general population without commensurate improvement. Treatment protocols tend to be “syndrome specific”.  As such, they do not generalise well in terms of training and application, making them expensive and difficult to disseminate, suggesting the desirability of developing a cross-diagnostic approach. The general basis of such a CBT grounded transdiagnostic approach is considered, and the particular need to incorporate cognitive elements of both anxiety/health anxiety (threat) and depression (loss) is highlighted. Key empirically grounded and evidence based processes (both specific and general) previously identified as underpinning the maintenance of these problems are delineated. However, the need to take more problem specific issues into account in treatment is identified, suggesting that the optimum treatment may be a hybrid cross-diagnostic/specific approach with formulation, shared understanding, belief change strategies and behavioural experiments at its heart.

Persistent physical symptoms: something old, new, borrowed and blue

Trudie Chalder, King’s College London


This keynote will discuss recent developments in the area of medically unexplained symptoms from a clinical and research perspective. Many IAPT services are soon to be treating long term conditions and medically unexplained symptoms; The specific adaptation of the clinical skills required for treating patients with MUS will be described.

Thrive: How better psychological therapy provision transforms lives and saves money

David Clark, University of Oxford


The prospects for people with mental health problems have greatly improved in recent years. We now have effective psychological treatments for a wide range of problems. However, most people with mental health problems don’t get a chance to benefit from these advances. Medication remains the most common intervention despite the fact that the public has a 3:1 preference for psychological therapies. This talk highlights the compelling economic arguments for making psychological therapies much more widely available and then focuses on two complementary approaches to dissemination
The first approach is to develop delivery methods (such as internet based therapy) that require less therapist time and have a wider geographical reach without loss of effectiveness. This approach is illustrated by describing the development and evaluation of a version of cognitive therapy for social anxiety that delivers all the key features (including video feedback) of this complex therapy over the internet.
The second approach is to create a radical regional programmes that train large numbers of new therapists and deploys them in evidence-based services with universal outcome monitoring and public transparency. This approach is illustrated with the overview of the current status of the English Improving Access to Psychological Therapies (IAPT) programme, which is the world’s largest attempts to disseminate evidence-based psychological therapies to the general public. Currently IAPT treats around 550,000 people with depression or anxiety each year and obtains pre and post treatment outcome data on 98% of these individuals. Analysis of this data is providing invaluable clues about the best way to deliver psychological therapies effectively and economically.