EABCT 2022 - Workshop Programme

WORKSHOP 1: A developmental and family-informed treatment model for anxiety in youth at the transition to adulthood

Anne Maria Albano, Columbia University, NY, USA

In the early 2000’s, a new stage of “emerging adulthood” characterized the typical developmental transition from adolescence to early adulthood as a time of uncertainty and anxiety but also optimism and growth (Arnett, 2004). Rather than defined by an age cut off, attaining “adult” status takes time and is comprised of meeting the tasks and challenges of functioning independently within a range of behavioural, cognitive, and emotional dimensions. Along the path of development, youth with anxiety disorders typically experience everyday tasks and challenges as insurmountable as compared to their non-anxious peers, often resulting in a failure to achieve independent functioning. Although CBT and medication are effective treatments for anxiety in adolescents and children (Walk-up, et al., 2008), long-term remission through the transition to adulthood is not maintained for nearly half of effectively treated youth (Ginsburg et al., 2014). Dr Albano will present on the unique contextual features of the environments and situations experienced by adolescents and young adults, and the need to improve upon CBT outcomes through the adaptation of family-based interventions as well as the delivery of exposures that are ecologically valid to the youth. The Launching Emerging Adults Program (LEAP) will be presented, a model integrating the core components of effective CBT for anxiety in adolescents and young adults with novel components designed to address patient-caretaker dependency, role transitions, and attainment of behaviours necessary for independent functioning. Dr. Albano will present the LEAP-specific developmental assessment and treatment protocol with an emphasis on novel components including: negotiating a developmental hierarchy, planning for parental “letting go” while engaging and addressing core beliefs and fears of the parents and their emerging adult child, and engaging youth in contextually sound exposures. Adaptations of the treatment in the context of unique challenges presented during the global pandemic will be discussed.

Keywords: Adolescents, Young adults, Family, Development, CBT

At the conclusion of this workshop, participants will be able to:

Recognize the normative tasks of development necessary for youth (ages 13-26) to transition to adulthood
Understand specific and unique challenges for youth, including the impact of the pandemic on youth mental health and development
Devise strategies for recognizing and intervening in parental over involvement and adolescent dependency, including family beliefs, communication and problem solving
Develop exposures that maximize the use of context and address developmental stage issues to increase ecological validity and reduce or develop tolerance of anxiety

References:

Arnett, Jeffrey Jensen (2004). Emerging adulthood: The winding road from late teens through the twenties. New York: Guilford Press.

Ginsburg, G.S., Becker-Haimes, E.M., Keeton, C., Kendall, P.C., Iyengar, S., Sakolsky, D., Albano, A.M., Peris, T., Compton, S.N., & Piacentini, J. (2018). Results from the Child/Adolescent Anxiety Multimodal Extended Long Term Study (CAMELS): Primary anxiety outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 57, 471-480.

Hoffman, L., Guerry, J., & Albano, A.M. (2018). Anxiety Disorders: Transitional Age Youth. Current Psychiatry Reports: Child and Adolescent Disorders, 20: 25. Philadelphia: Springer. https://doi.org/10.1007/s11920-018-0888-9, 10.1007/s11920-018-0888-9

WORKSHOP 2: Use of the Internet to provide cognitive behaviour therapy in 2022

Gerhard Andersson, Linköping University, Sweden

Guided Internet-delivered CBT (ICBT) has been tested in well over 300 randomized controlled trials and comparisons with face-to-face CBT indicate that the two treatment formats can perform equally well. It is clear from the literature that pure self-help treatments without guidance are less effective, but on the other hand, these treatments may serve as a first step in a stepped care process. However, guided Internet-delivered CBT can be suitable not only as a first step but as an alternative to individual or group-based CBT. It can also be blended with face-to-face meetings. Among the advantages of guided Internet-delivered CBT are cost-effectiveness, convenience, and that it saves therapist time. In this workshop, I will describe how ICBT is conducted and will give examples of programs for a range of conditions and target groups. I will also explain how we develop new internet treatments for condition like loneliness and low self-esteem. Further, the role of ICBT in an era of pandemics will be covered

Key learning objectives

Understanding the varieties of Internet treatments and their differential effects

Getting to know what is needed to set up a service using the Internet (the basics)

Learning what is required to obtain good outcomes with guided Internet treatment

Knowing what is required in terms of therapist training and skills.

Learning about the pros and cons of Internet treatment including tailoring treatment according to patient symptom profile.

Teaching methods:

Making decisions regarding the structure of a self-help treatment presented via the Internet (based on own practice/experience).

Practice on handling therapist contact online, e.g., how to provide feedback to foster adherence.

Problem solving exercise on how to handle difficult cases (e.g., suicidal ideation, poor adherence).

References

Andersson, G., Titov, N., Dear, B. F., Rozental, A., & Carlbring, P. (2019). Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry, 18, 20-28.

Andersson, G. (2018). Internet interventions: past, present and future. Internet Interventions, 12, 181-188.

Andersson, G., & Berger, T. (2021). Internet approaches to psychotherapy: Empirical findings and future directions. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (50th anniversary edition ed., pp. 749-772): Wiley.

WORKSHOP 3: Creating New Ways of Being for ourselves: A self-practice/self-reflection (SP/SR) workshop

James Bennet-Levy, University of Sydney, Australia and Tobyn Bell, Greater Manchester CBT Training Centre and University of Manchester UK

CBT has traditionally focused on targeting ‘negative’ or unhelpful maintenance cycles. However, there is growing evidence for the benefit of creating and building new patterns of experience and self-representation. The notion of ‘building’ the new rather than (or in addition to) ‘dismantling’ the old is particularly relevant for clients with low self-esteem, shame, self-criticism and perfectionism. These transdiagnostic issues may continue to render clients vulnerable to mental health problems, even when a primary ‘disorder’ has been treated successfully.

This notion of creating and building the new ways of doing and being may also be particularly relevant for therapists seeking opportunities and frameworks for personal and professional development. One such framework is the “Old & New Ways of Being” framework, which drew on the previous work of Christine Padesky (Old/New Systems) and Kees Korrelboom’s COMET training. This Old & New Ways of Being approach, which was introduced in a self-experiential workbook for therapists (Bennett-Levy et al., 2015), involves a focus on strengths-based experiential and enactive practices to create memorable new experiences of acting, thinking, and feeling.

In this self-experiential workshop, participants will be introduced to the Old & New Ways of Being Model. They will then have the opportunity to build and practice their own ‘New Ways of Being’, using the therapist skill development approach known as self-practice/self-reflection (SP/SR) (Bennett-Levy et al., 2001, 2015; Kolts et al., 2018). SP/SR workshops differ from traditional therapist training. In SP/SR workshops, therapists use their own issues (of mild to moderate - not major – severity) to explore the value of different therapeutic strategies and learn the skills ‘from the inside out’. To do so, the facilitators create a safe environment (confidentiality agreements, recognition that we are all learners etc.) to acquire and build these skills.

This SP/SR workshop will focus on the use of 3 sets of experiential skills:

Imagery (Bell et al., 2015; Hackmann et al., 2011)
Chairwork (Bell et al., 2021; Pugh, 2019)
Behavioural experiments (Bennett-Levy et al., 2004)

In line with the SP/SR model, structured reflective processes – individual and group, written and verbal – will be used to draw out key learnings.

Key learning objectives:

Anticipated outcomes for participating therapists are:

An appreciation of the importance of building new ways of being and ways to formulate this process
Enhanced understanding of the importance and value of experiential and emotion-focused processes in psychotherapy
]Enhancement of imagery skills
Enhancement of behavioural experiments skills
Enhancement of chairwork skills
Enhanced confidence to use the above skills in their clinical practice

James Bennett-Levy is Professor in Mental Health and Psychological Wellbeing at the University of Sydney, Australia. He is a recognised leader in the field of therapist training. His influential models of therapist skill development – the Declarative-Procedural-Reflective model (2006, 2007, 2009) and the Personal Practice model (2018, 2019) have been widely adopted internationally, as has his pioneering self-experiential approach to therapist training, known as self-practice/self-reflection (SP/SR) (2001-2022). He has co-authored 5 books for therapists: the Oxford Guides to Behavioural Experiments (2004), to Low Intensity CBT Interventions, (2010), and to Imagery in Cognitive Therapy (2011), and two self-practice/self-reflection (SP/SR) books for therapists: Experiencing CBT from the Inside Out (2015) and Experiencing Compassion Focused Therapy from the Inside Out (2018).

Tobyn Bell is a Compassion Focused Therapy Trainer, Supervisor and Psychotherapist. His is also an accredited Schema Therapist and Cognitive Behavioural Psychotherapist. He is a co-founder of Chairwork (www.chairwork.co.uk) and a co-author of the book ‘Compassion Focused Therapy from the Inside Out: A Self-practice/Self-reflection Workbook for Therapists’. Tobyn regularly provides national and international training on compassion and chairwork, and is actively involved in ongoing research within these areas. He currently works as a lecturer and operational lead at the University of Manchester.

Key References

Bell, T., Mackie, L., & Bennett-Levy, J. (2015). 'Venturing towards the dark side': The use of imagery interventions by recently qualified cognitive-behavioural therapists. Clinical Psychology and Psychotherapy, 22, 591-603.

Bell, T., Montague, J., Elander, J., & Gilbert, P. (2021). Multiple emotions, multiple selves: compassion focused therapy chairwork. The Cognitive Behaviour Therapist, 14.

Bell, T., Hickey, T., & Bennett-Levy, J. (2021). Self-practice/ self-reflection (SP/ SR) training for compassion-focused therapists. In G. Simos & P. Gilbert (Eds.), Compassion focused therapy: Clinical practice and applications (pp. 371-384). Routledge, London.

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.

Bennett-Levy, J., Thwaites, R., Haarhoff, B. & Perry, H. (2015): Experiencing CBT from the inside out: A self-practice/self-reflection workbook for therapists. Guilford, New York.

Bennett-Levy, J., Turner, F., Beaty, T., Smith, M., Paterson, B. & Farmer, S. (2001). The value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists. Behavioural and Cognitive Psychotherapy, 29, 203-220.

Hackmann, A., Bennett-Levy, J. & Holmes, E.A. (2011). The Oxford guide to imagery in cognitive therapy. Oxford University Press, Oxford.

Kolts, R., Bell, T., Bennett-Levy, J. & Irons, C. (2018). Experiencing compassion focused therapy from the inside out: A self-practice/self-reflection workbook for therapists. Guilford, New York.

Pugh, M. (2019). Cognitive behavioural chairwork: Distinctive features. Routledge, London.

WORKSHOP 4: Relapse prevention for depression using Preventive Cognitive Therapy: why, how and for whom and implications for other common health conditions

Claudi Bockting, University of Amsterdam, the Netherlands

A crucial part of the treatment is the prevention of relapse and recurrence. Sequential Preventive Cognitive Therapy (PCT), as started after remission, is effective in preventing relapse and recurrence in recurrent depression, also as alternative to long term use of antidepressants and on top of antidepressants. A short overview will be given of the effectivity of PCT as studied in several Randomised Controlled Trials (Bockting et al., 2018, 2009, 2005, Biesheuvel-Lelieveld, 2017, de Jonge et al., 2019) as well as the application of PCT in pregnant women that wish to stop antidepressants (Brouwer et al., 2020).

Specific ingredients of PCT will be discussed, interventions will be demonstrated (video) and role played, including the use of positive imagery to evaluate schemata and beliefs. Divers types of PCT, that is video- based-PCT, face to face PCT, guided self-help-PCT in primary care and guided internet-based PCT will be demonstrated. The latest insights based on Individual Patient Data analyses will be shared to inform clinicians on what works for whom in relapse prevention (Breedvelt et al., 2021). Clinical and research implications will be discussed.

Key learning objectives:

Gain knowledge on risk factors of relapse in depression and anxiety disorders
Gain knowledge on the evidence for psychological interventions developed to prevent relapse
Gain knowledge on the evidence personalization of relapse prevention strategies (that is PCT, MBCT, antidepressants)
Knowing the key interventions of PCT
Being able to apply the main interventions (also via videocall, self-help)

As scientist practitioner and a professor of Clinical Psychology in Psychiatry at Amsterdam University Medical Centers/co-director the interdisciplinary Centre for Urban Mental Health at the University of Amsterdam her focus is on common mental health disorders (such as depression and relapse prevention (for a personal profile in Lancet Psychiatry see: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30562-9/fulltext). She studies with her team potentially modifiable etiological factors of onset, relapse and chronicity using an interdisciplinary complex systems approach. She is a (co-)author of 170 peer reviewed publications. She developed PCT implemented in clinical guidelines (English; under review, Spanish, 2021, Dutch 2009) and wrote several chapters on relapse prevention for English textbooks (e.g. The Oxford Handbook of Mood Disorders). She was the main editor of 11 clinical handbooks including treatment manuals. In addition, she developed several other treatment manuals for common mental health conditions, including e- interventions and chatbots (fellow at the World Health Organisation). In 2014 she was awarded with a Fellowship at Beck Institute International Scholarship Philadelphia. For more information see www.claudibockting.com.

Key References

Biesheuvel-Leliefeld. K. E. M., Dijkstra-Kersten, S.M.A. , van Schaik, D.J.F., van Marwijk, H. W. J., Smit, F., van der Horst, H.E., Bockting, C. L. H. (2017). Effectiveness of supported self help in recurrent depression: a randomised controlled trial in primary care. Psychotherapy and Psychosomatics, 86(4), 220-230, doi: 10.1159/000472260.
Breedvelt J. J. F., Warren F. C., Segal Z., Kuyken W., Bockting C. L. H. Continuation of Antidepressants vs Sequential Psychological Interventions to Prevent Relapse in Depression: An Individual Patient Data Meta- Analysis. JAMA Psychiatry. Published online May 19, 2021. doi:10.1001/jamapsychiatry.2021.0823
Brouwer, M. E., Molenaar, N. M., Burger, H., Williams, A. D., Albers, C., Lambregtse-van den Berg, M., & Bockting, C. L. H. (2020). Tapering antidepressants while receiving digital Preventive Cognitive Therapy during pregnancy: An experience sampling methodology trial. Frontiers in Psychiatry. doi.org/10.3389/fpsyt.2020.574357
Bockting, C. L. H., Schene, A. H., Spinhoven, P., Koeter, M. W. J., Wouters, L. F., Huyser, J., & Kamphuis, J. H. (2005). Preventing relapse/recurrence in recurrent depression using cognitive therapy. Journal of Consulting and Clinical Psychology, 73, 647-657. doi: 10.1037/0022-006X.73.4.647.
Bockting, C. L. H. (2009). Preventive cognitieve therapy in recurrent depression. Houten: Bohn Stafleu van Loghum.
Bockting, C. L. H. (2009). No more: workbook for prevention of relapse in depression. Houten: Bohn Stafleu van Loghum.
Bockting, C. L. H., Klein, N. S., Elgersma, H. J., van Rijsbergen, G. D., Slofstra, C., Ormel, J., Burger, H. (2018). Effectiveness of preventive cognitive therapy while tapering antidepressants versus maintenance antidepressant treatment versus their combination in prevention of depressive relapse or recurrence (DRD study): A three-group, multicentre, randomised controlled trial. Lancet Psychiatry, 5(5), 401-410. doi:10.1016/s2215-0366(18)30100-7
de Jonge, M., Bockting, C. L. H., Kikkert, M. J., van Dijk, M. K., van Schaik, D. J. F., Peen, J., . . . Dekker, J. J. M. (2019). Preventive cognitive therapy versus care as usual in cognitive behavioral therapy responders: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 87(6), 521-529. doi:10.1037/ccp0000395

WORKSHOP 5: Training Emotion Regulation in Children & Adolescents (EuREKA)

Laura Wante, Elisa Boelens and Caroline Braet, Ghent University, the Netherlands

Emotion regulation plays an important role in the development and maintenance of various mental health problems in children and adolescents (e.g. depression, anxiety, eating and weight problems, addiction, behavioral problems; (Gratz, Weiss, & Tull, 2015; Gross, 2013). The current emotion regulation training for children and adolescents, EuREKA, is based on the evaluated Affect Regulation Training (ART) for adults, developed by Berking and Whitley (2013). It combines several well-evaluated techniques from Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Emotion-Focused Therapy, Solution-Focused Therapy, and Positive Therapy. The goal of the EuREKA training is to teach adolescents six crucial emotion regulation skills which have to be trained in a specific order: (1) breathing and muscle relaxation, (2) emotional awareness, (3) acceptance, (4) self-compassion, (5) understanding the situation/context, and (6) the active and flexible use of specific emotion regulation strategies. EuREKA is a science-based intervention as several pilot studies have been performed to evaluate parts of the training program. Moreover, the feasibility and effectiveness of the full training program have been evaluated in several studies using various designs, such as a multiple baseline case series study and an RCT.

Key learning objectives:

Participants will be able to:

Define emotion regulation and discuss the transdiagnostic role of this mechanism
List the most important parts the training protocol and identify important preconditions
Use the most central techniques of the training protocol
Discuss and evaluate important pitfalls of the treatment protocol

Laura Wante is a postdoctoral researcher at Ghent University. Her research focuses on the evaluation of a new training focused on emotion regulation and cognitive control in depressed adolescents. Next to her research activities, Laura works as a clinical psychologist at the University treatment center for children and adolescents. Elisa Boelens is doing her PhD at the Department of Developmental, Personality and Social Psychology at Ghent University where she is doing a research project on investigating and training emotion regulation in youth. Furthermore, she is a clinical psychologist working with children and adolescents with both internalizing and externalizing problems. Caroline Braet is full professor and Head of the Department of Developmental, Personality, and Social Psychology at Ghent University. She is teaching developmental and clinical aspects of developmental psychopathology and childhood therapy. As licensed cognitive behaviour therapist, she is also involved in postgraduate courses on ‘Cognitive Behaviour Therapy’ and ‘Clinical assessment in children’ and she is coordinator, supervisor & therapist of children and adolescents with mental health problems in the Ghent University Child Mental Health Centre (www.kindenadolescent.be ), situated in the University.

Key References

Berking, M., & Lukas, C. A. (2015). The Affect Regulation Training (ART): a transdiagnostic approach to the prevention and treatment of mental disorders. Current Opinion in Psychology, 3, 64-69.Berking, M., & Whitley, B. (2014). The adaptive coping with emotions model (ACE model). In Affect regulation training (pp. 19-29). Springer, New York, NY.Debeuf, T., Verbeken, S., Boelens, E., Volkaert, B., Van Malderen, E., Michels, N., & Braet, C. (2020). Emotion regulation training in the treatment of obesity in young adolescents: protocol for a randomized controlled trial. Trials, 21(1), 153.Gratz, K. L., Weiss, N. H., & Tull, M. T. (2015). Examining emotion regulation as an outcome, mechanism, or target of psychological treatments. Current opinion in psychology, 3, 85-90.Volkaert, B., Wante, L., Vervoort, L., & Braet, C. (2018). ‘Boost Camp’, a universal school-based transdiagnostic prevention program targeting adolescent emotion regulation; evaluating the effectiveness by a clustered RCT: a protocol paper. BMC public health, 18(1), 1-14.

WORKSHOP 6: Clinical interventions for persistent symptoms: transdiagnostic or symptom focused

Trudie Chalder, King’s College London, UK

Fatigue is a common symptom in the general population with a prevalence of about 18.3%. It is also associated with a range of long-term conditions such as multiple sclerosis, cancer and long Covid. But is it necessary to have a different approach to treating fatigue in each condition and is a trained therapist needed? From a trans-diagnostic perspective, theory suggests that cognitive, behavioural, affective and social associations of and responses to fatigue may be similar across different diseases. They may therefore respond to similar treatment approaches regardless of the specific diagnosis. This workshop will focus on how to target trans-diagnostic processes associated with fatigue and will examine the evidence for such an approach.

Key learning objectives

To gain an understanding of the specific affective, cognitive, behavioural and social responses that may be perpetuating symptoms and disability
To gain an understanding of the most effective interventions for fatigue in a variety of contexts
To be able to formulate the patient’s problems with compassion

Trudie Chalder is Professor of Cognitive Behavioural Psychotherapy at King’s College London. She develops cognitive behavioural models for understanding and treating somatic symptoms such as fatigue and evaluates such approaches in randomised controlled trials. Not only is she interested in whether something works but how it works and for whom. She has trained and supervised many practitioners over the years and is passionate about implementation of evidence-based treatments across the National Health Service

Key References
Hughes AM, Campbell LJ, Graham H, Post F, Chalder T. A biopsychosocial approach to HIV fatigue: A cross-sectional and prospective analysis to identify key modifiable factors. Behav Med. 2020 Feb 20;1-9. doi.org/10.1080/08964289.2020.1712582
Hughes A, Suleman S, Rimes K, Marsden J, Chalder T. Cancer-related fatigue and functional impairment: towards an understanding of cognitive and behavioural factors. J Psychosom Res. 2020 Jul:134;110127. doi.org/10.1016/j.jpsychores.2020.110127
Adamson J, Ali S, Santhouse AM, Wessely S, Chalder T. Cognitive behavioural therapy for chronic fatigue and CFS: outcomes from a specialist clinic in the UK. JRSM Open. 2020 Sept 15. doi.org/10.1177/0141076820951545
Ali S, Matcham F, Irving K, Chalder T. Fatigue and psychosocial variables in autoimmune rheumatic disease and chronic fatigue syndrome: a cross-sectional comparison. J Psychosom Res. 2017;92:1–8. doi.org/10.1016/j.jpsychores.2016.11.002
Rogers DC, Dittner AJ, Rimes KA, Chalder T. Fatigue in an adult attention deficit hyperactivity disorder population: a trans-diagnostic approach. Br J Clin Psychol. 2017;56(1):33-52. doi.org/10.1111/bjc.12119
Hughes AM, Chalder T, Hirsch CR, Moss-Morris R. An attention and interpretation bias for illness-specific information in chronic fatigue syndrome. Psych Med. 2017;47(5):853–865. doi.org/10.1017/S0033291716002890
Borsini A, Hepgul N, Mondelli V, Chalder T, Pariante CM. Childhood stressors in the development of fatigue syndromes: a review of the past 20 years of research. Psychol Med. 2014;44(9):1809–23. doi.org/10.1017/S0033291713002468

WORKSHOP 7: Effective Strategies to Work with Negative Thinking in Depression

Keith Dobson, University of Calgary, Canada

One of the most challenging aspects of CBT is the ability to recognize, name and work effectively to modify dysfunctional thoughts and underlying core beliefs that lead to problems for the client. In this workshop several key strategies to identify negative thoughts and core beliefs that commonly occur in depression will be reviewed and demonstrated. The three main methods of evidence- based, alternative- based and meaning- based strategies will be distinguished and presented. The key strategy of assessing the client’s desire for belief change will be discussed, and the ethics of belief modification will be also reviewed, before several effective strategies for belief modification are described and presented.

Key learning objectives

Identify negative cognitive patterns associated with Major Depression
Use cognitive case conceptualization to identify cognitive targets for change
Understand the three major types of interventions for negative cognitions in depression.
Recognize the major strategies for core belief work in depression.

Dr. Dobson is a Professor of Clinical Psychology at the University of Calgary. His research has focused on both models and the treatment of depression, particularly using cognitive-behavioural therapies. Dr. Dobson’s research has resulted in over 300 published articles and 80 chapters, 17 books, and conference and workshop presentations in many countries. His recent books include the Handbook of Cognitive-behavioral Therapies, 4th Edition (2019) and The Stigma of Mental Illness (2021). In recognition of his work he has received numerous awards, including Fellow status in the Academy of Cognitive- behavioral Therapy, the Canadian Academy of Health Sciences and the Royal Society of Canada.

Key References
Dobson, D. J. G., & Dobson, K. S. (2017). Evidence-based Practice of cognitive behavior therapy, 2^nd edition. New York, NY: Guilford Press.
Kazantzis, N. Dattilio, F. M., & Dobson, K. S. (2017). The therapeutic relationship in cognitive behavior therapy: The Heart and Soul of Effective Practice. New York, NY: Guilford Press.

WORKSHOP 8: The Unified Protocol: A Transdiagnostic Approach to the Treatment of Emotional Disorder

Todd Farchione, Boston University, USA

Recent conceptualizations of anxiety, depressive, and related “emotional” disorders emphasize their similarities rather than their differences. In response, there has been a movement in recent years away from traditional disorder-specific manuals toward treatment approaches that focus on addressing core psychological processes that appear to cut across disorders rather than surface-level, DSM diagnostic symptoms. These “transdiagnostic” evidence-based treatments may prove to be more cost efficient and have the potential to increase availability of evidence-based treatments to meet a significant public health need. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Barlow et al., 2017; UP), developed by Dr. David Barlow and colleagues, is the most widely used transdiagnostic treatment with empirical support for its use. The UP is an emotion-focused, cognitive-behavioral treatment (CBT) consisting of five core modules that targets the temperament of neuroticism, and associated temperamental characteristics, underlying all anxiety, depressive, and related disorders. This introductory workshop will first briefly discuss the rationale for a transdiagnostic approach to treatment and review evidence supporting the UP. This will be followed by a description and demonstration of how to apply core UP treatment modules, along with the similarities and differences between the UP and traditional CBT. Attendees are expected to develop a greater understanding of the UP and increase their ability to effectively apply this treatment in clinical practice.

Key learning objectives:

Identify core temperamental characteristics and deficits in emotion regulation underlying all anxiety, depressive, and related disorders and conceptualize a case from the UP’s transdiagnostic framework.
Describe the UP’s 5 core emotion-focused treatment strategies and how these can be applied to patients presenting with comorbid emotional disorders.
Create effective and cohesive emotion exposures for patients with anxiety, depression, and complex comorbidities.

Dr. Farchione is currently a Research Associate Professor in the Department of Psychological and Brain Sciences at Boston University (BU). He has been a member of the clinical research group at the Center for Anxiety and Related Disorders at BU (CARD) for nearly twenty years. He currently directs a transdiagnostic research program at BU focusing on emotion regulation processes, identifying mechanisms of change in treatment, and on developing new preventative measures and improved treatments for emotional disorders. Dr. Farchione is one of the co-developers of the UP and has collaborated with Dr. Barlow and others on research aimed at the development and evaluation of this treatment protocol. He has also worked extensively with this intervention clinically and has considerable experience training and supervising clinicians in the use of this protocol.

Key references
Barlow, D., Farchione, T. J., Sauer-Zavala, S. E., Latin, H., Ellard, K. K., Bullis, J. R., Cassiello-Robbins, C. (2017). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, Therapist Guide, Second Edition.
Barlow, D., Sauer-Zavala, S. E., Farchione, T. J., Latin, H., Ellard, K. K., Bullis, J. R., Cassiello-Robbins, C. (2017). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, Workbook, Second Edition

WORKSHOP 9: Exploring attachment and caring behaviour in the cognitive behaviour therapies

Paul Gilbert, University of Derby and the Compassionate Mind Foundation, UK

This workshop will touch on the evolution of caring behaviour and then focus in on mammalian and human attachment dynamic. It will highlight that motives are run by algorithms of ‘if A then do B’. Caring motives are rooted in the stimulus response algorithm of ‘if there is a signal/stimulus of distress or needs then behave to relieve distress and address needs. There is increasing evidence that we can identify the evolved physiological mechanisms of that algorithm linked to (for example) oxytocin, the vagal nerve plus various neuro circuits in the frontal cortex. Caring behaviour introduced a new threat regulation system derived from social safeness. There is also increasing evidence that caring behaviour impacts multiple physiological systems including epigenetics with implications for physical and mental health. The workshop will guide participants through the complexities of caring behaviour in terms of developing secure base and safe haven and how those functions can be recruited into developing a compassionate mind. the compassionate mind with its physiological signatures then becomes the grounding for cognitive behavioural interventions

Key learning objectives:

insight into the evolution and physiological systems underpinning caring behaviour.
understanding how stimulating care focus motivational systems play a major role in threat regulation and also exploited behaviour
how to utilise these systems through compassionate mind training

Paul Gilbert, FBPsS, PhD, OBE is Professor of Clinical Psychology at the University of Derby and honorary visiting Prof at the University of Queensland. Until his retirement from the NHS in 2016 he was Consultant Clinical Psychologist for over 40 years. He has researched evolutionary approaches to psychopathology with a special focus on mood, shame and self-criticism in various mental health difficulties for which Compassion Focused Therapy was developed. He was made a Fellow of the British Psychological Society in 1993, president of the BABCP 2002-2004, and was a member of the first British Governments’ NICE guidelines for depression. He has written/edited 23 books and over 250 papers and book chapters. In 2006 he established the Compassionate Mind Foundation as an international charity with the mission statement To promote wellbeing through the scientific understanding and application of compassion.

Key references

Gilbert, P & Simos, G (in press) Compassion Focused Therapy: Clinical practice and applications. London. Routledge.Gilbert, P. (2020). Compassion: From its evolution to a psychotherapy. Frontiers in psychology 11, doi:10.3389/fpsyg.2020.58616 (open access)
Music, G (2017). Nurturing natures attachment and children’s emotional social cultural and brain development. Second edition. Routledge
Holmes, J., & Slade, A. (2017). Attachment in therapeutic practice. London: Sage.

WORKSHOP 10: Cognitive Therapy for Psychosis: Back to Basics

Tony Morrison, University of Manchester, UK

This workshop will outline a cognitive approach to the understanding of distressing psychotic experiences, which suggests that it is the interpretation of these intrusions and problematic responses to them that causes the associated distress and disability. Specific issues to be covered include development of formulations, using these to derive intervention strategies, common verbal reattribution strategies, use of behavioural experiments and homework tasks (including for therapists). This will be delivered in the context of the manualised protocol that has been extensively evaluated in randomized controlled trials. The workshop will assume knowledge of and basic skills in cognitive therapy and some experience of working with people with psychosis. Learning outcomes will include the ability to develop formulations based on the model, knowledge of how to utilise these to collaboratively select change strategies and both practice and observation of common change strategies to promote understanding of their use.

Key learning objectives:

Participants should be able to –

Understand the rationale for the use of CT for people with psychosis
Develop case formulations based on a cognitive model
Select treatment strategies based on such formulations

Tony Morrison is a Professor of Clinical Psychology at the University of Manchester and also Director of the Psychosis Research Unit at Greater Manchester Mental Health Foundation Trust. He has published widely on cognitive therapy for psychosis with over 200 articles on cognitive behaviour therapy for psychosis and experimental studies of cognitive processes in psychosis, including an influential cognitive model of psychosis, and has conducted numerous randomised controlled trials of cognitive behaviour therapy for psychosis, including the only trials to compare CBT with antipsychotic medication in head-to-head comparisons. He has recently been a member of 2 NICE guideline development groups for psychosis and schizophrenia in adults and children/young people.

Key references

Brabban A, Byrne R, Longden E, Morrison AP. The importance of human relationships, ethics and recovery-orientated values in the delivery of CBT for people with psychosis. Psychosis: Psychological, social and integrative approaches. 2016.
Morrison, A. P., Renton, J. C., French, P., & Bentall, R. P. (2008). Think you're crazy? Think again: A resource book for cognitive therapy for psychosis. London: Routledge.
Morrison AP. A manualised treatment protocol to guide delivery of evidence-based cognitive therapy for people with distressing psychosis: learning from clinical trials. Psychosis: Psychological, social and integrative approaches. 2017.

WORKSHOP 11: Somatic symptoms in psychopathology: A mechanistic approach to treatment

Omer van den Bergh, University of Leuven, Belgium and Michael Witthöft, Johannes Gutenberg University of Mainz, Germany

Somatic symptoms in psychopathology: A mechanistic approach to treatment.Depressive, anxiety and trauma-related disorders are often accompanied with somatic symptoms (e.g., pain, fatigue, dizziness). Also, a substantial number of patients in primary and secondary medical care consults for somatic symptoms that cannot be linked to bodily dysfunction and are considered nonspecific, functional and/or stress-related. In addition, somatic symptoms are the core of somatic symptom or bodily distress disorders according to DSM-5 and ICD-11, respectively. Often it is not clear whether and how such symptoms should be targeted and commonly they are considered epiphenomena of a larger cognitive-emotional problem that should be focused upon. In the workshop, we describe a new model to understand the often loose relationship between somatic symptoms and bodily dysfunction and discuss how compromised interoception may result in an intricate relationship between experiences of somatic symptoms and states of negative affect. From this view, we derive clinical implications for a comprehensive assessment and mechanistic treatment. In particular, we will discuss how stress-related physiology and nocebo-like cognitive mechanisms dynamically interact to produce vicious circles and self-fulfilling prophecies maintaining somatic symptoms and dysfunctional behavioural responses (e.g. avoidance of physical activity and other suspected symptom triggering factors) on the longer term leading to disability and demoralization. We will discuss and demonstrate new ways to counter such mechanisms.

Key learning objectives:

To understand the often loose relationship between experienced bodily symptoms and somatic activity and dysfunction
To be able to detect the critical mechanisms of the model in a patient’s story and to foster an understanding of the crucial mechanisms in patients
To influence those mechanisms to the benefit of the patient.

Omer Van den Bergh is emeritus professor of health psychology at the University of Leuven, Belgium. He has been trained as a CBT-therapist and has extensive clinical experience in treating patients with stress-related problems, somatization disorder and medically unexplained symptoms in primary and secondary care. http://www.kuleuven.be/wieiswie/en/person/00005032 Omer is an expert in the broad area of the relationship between health and behavior. Specific key words in his work are symptom perception and (respiratory) psychophysiology in response to stress and aversive somatic experiences. His research involves both normal subjects in laboratory experiments, clinical studies on psychosomatic and pulmonary patients in the university hospital, and field studies on subjective health symptoms. He published over 300 papers and chapters in international journals and books. Michael Witthöft is professor of clinical psychology, psychotherapy, and experimental psychopathology at the Johannes Gutenberg-University of Mainz, Germany. He is a licensed psychotherapist specialized in CBT with extensive experience in the treatment of anxiety disorders, somatoform disorders, and pathological health anxiety. https://klipsy.uni-mainz.de/abteilungsmitglieder/witthoeft/

Key References:

Van den Bergh, O., Bräscher, A.-K. & Witthöft, M. (2021). Idiopathic Environmental Intolerance: A treatment model. Cognitive and Behavioral Practice, 28, 281-292. https://doi.org/10.1016/j.cbpra.2020.05.002
Van den Bergh, O., Brosschot, J., Critchley, H., Thayer, J. F., & Ottaviani, C. (2021). Better Safe Than Sorry: A Common Signature of General Vulnerability for Psychopathology. Perspectives on psychological science, 16(2), 225–246. https://doi.org/10.1177/1745691620950690
Van den Bergh, O., & Walentynowicz. M. (2016). Accuracy and bias in retrospective symptom reporting. Current Opinion in Psychiatry, 29, 302-308. doi: 10.1097/YCO.0000000000000267
Van den Bergh, O., Witthöft, M., Petersen, S. & Brown, R.W. (2017). Symptoms and the body: Taking the inferential leap. Neuroscience & Biobehavioral Reviews, 74, 185-203. doi: 10.1016/j.neubiorev.2017.01.015
Witthöft, M., Gropalis, M., & Weck, F. (2018). Somatic symptom and related disorders. In J. N. Butcher & J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and treating adult mental disorders (pp. 531–556). American Psychological Association. https://doi.org/10.1037/0000064-022

WORKSHOP 12: Using Imagery Techniques to Help People with Complicated and Complex PTSD

Kerry Young, Woodfield Trauma Service, London and Oxford Rose Clinic, Oxford, UK

Distressing, imagery-based intrusive memories and flashbacks to past trauma are the hallmark of post-traumatic stress disorder (PTSD) and Complex PTSD. Mental imagery has interesting properties; it recruits similar brain areas to actual perception and, compared to verbal processing, it has a more powerful impact on emotion. Learning how to ‘harness’ the power of mental imagery to help alleviate distress is an important tool for anyone working with complicated/Complex PTSD. In particular, using mental imagery techniques can help clinicians to remain trauma-focused, even when feared consequences do happen during a traumatic event or where what happens is so terrible that it is hard to contemplate exposure (e.g. traumatic death, rape and torture.) In this workshop, we will learn how to use imagery re-scripting (ImRs; Arntz & Weertman, 1999) as a standalone treatment for this client group. In addition, we will discuss how to use ImRs and metacognitive techniques to enhance other trauma-focused methods of working with PTSD and CPTSD (for example Cognitive Therapy for PTSD; Ehlers and Clark, 2001.)

Key learning objectives

Learn about the neuroscientific findings which help to explain the power of mental images and how ImRs works
How to select treatment targets within complex trauma presentations
Illustrate the basic method of ImRs for adult and childhood traumatic events
Discuss when and how to use ImRs and metacognitive techniques within other trauma-focused therapies
Show what the techniques look like in clinical practice

Kerry Young is a Consultant Clinical Psychologist and Clinical Lead of the Woodfield Trauma Service in London, UK, a leading centre for the treatment of asylum seekers and refugees suffering from PTSD. She also works at the Oxford Rose Clinic, a service for the medical and psychological treatment of women who have experienced Female Genital Mutilation. She has advised national bodies on how to train clinicians to work with refugees, PTSD and Complex PTSD. Kerry is an expert in mental imagery techniques, particularly imagery re-scripting, and its life-changing use with clients who have experienced complex trauma. She has published in the field of trauma and mental imagery.

Key References
Arntz, A. (2012). Imagery Rescripting as a therapeutic technique: Review of clinical trials, basic studies and research agenda. Journal of Experimental Psychopathology, 3(2), 189-208
De Haan, K. L. B., Lee, C. W., Fassbinder, E., Van Es, S. M., Menninga, S., Meewisse, M. L., ... & Arntz, A. (2020). Imagery rescripting and eye movement desensitisation and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: randomised clinical trial. The British Journal of Psychiatry, 217(5), 609-615Holmes, E. A., & Mathews, A. (2010). Mental imagery in emotion and emotional disorders. Clinical Psychology Review, 30(3), 349-362.
Holmes, E., Hales, S., Young, K. & Di Simplicio (2019) Imagery Based Therapy for Bipolar Disorder and Mood Instability. Guilford Press
Pearson, J., Naselaris, T., Holmes, E. A., & Kosslyn, S. M. (2015). Mental imagery: functional mechanisms and clinical applications. Trends in Cognitive Sciences, 19(10), 590-602

Workshop Programme

Important dates

Technical Secretariat