OPENING ADDRESS – Wednesday 17th July at 17.30
Cognitive Behaviour Therapy at the Crossroads: Where We Have Been, Where We Are and the Challenges We Need To Face – Part 1
Sabine Wilhelm, Harvard Medical School, USA
While informal methods for assessing and treating mental distress existed through the ages, formal psychotherapy first began in Vienna in the 1890s with Sigmund Freud’s psychoanalysis – a system of psychological theories and therapeutic techniques aiming to uncover the unconscious and at understanding unresolved conflicts from childhood. However, psychoanalytic theories and treatment techniques lacked empirical support. Thus, clinicians began to look for therapies based on sounder science. The first wave of behavior therapy occurred during the 1950s and 1960s and delivered such empirical support. Behavior therapy is based on classical and operant conditioning and differed greatly from psychodynamic therapy in its focus on modifying problems and behaviors that occur in the present. In the early 1970s the next paradigm shift occurred. During the cognitive wave, previously disregarded cognitive factors were introduced into psychotherapy. Albert Ellis and Tim Beck led the field in identifying and changing self-defeating thoughts. The integration of the first two generations of behavior therapy resulted in the conception of cognitive behavioral therapy (CBT), a treatment not only focused on behavior change but also on the modification of maladaptive cognitions (including beliefs, assumptions and expectations) of the patient. Since CBT was first developed, countless successful outcome studies across psychological disorders have been published, to the extent that “empirically supported therapies” is often used synonymously with “CBT.” This is a tremendous accomplishment.
But we cannot rest on our laurels. Despite having good, empirically supported treatments, we face a wide gap in access to care. The majority of individuals suffering from a mental health problem worldwide receive inadequate clinical care or no care at all. Major barriers to obtaining empirically based interventions include the lack of trained professionals, and the cost and stigma associated with receiving mental health care. Furthermore, despite the fact that a large proportion of patients benefit from CBT, many do not respond, and even those who do improve often have significant residual symptoms at the end of treatment. To continue progressing, we need to harness advances in technology, with regard to clinician training, treatment delivery, and neuroscience, in order to develop more accessible, potent and personalized treatments.
In summary, this invited address will start with a brief review of the first two waves of CBT. I will then discuss the challenges our field is facing and will highlight the opportunities provided by advances in technology and neuroscience. Treatment development continues to progress and more recent forms of psychotherapy conceptualized as the third generation of behavioral therapies will be summarized by Susan Bögels in the subsequent presentation.
Cognitive Behaviour Therapy at the Crossroads: Where We Have Been, Where We Are and the Challenges We Need To Face – Part 2
Susan Bögels, University of Amsterdam, the Netherlands
A crossroad means “a point at which a crucial decision must be made which will have far reaching consequences”. Is CBT at its crossroads, and what crucial decisions should be taken? The world certainly is at a crossroads! Does treating anxiety disorders make sense given the state our world is in? How did therapists and scientists at the beginning of the second world war, when the world was falling apart, find meaning in their profession?
CBT cannot be seen without its context, the state of our current mental and physical health as well as the state of health care systems. Our health cannot be seen independently from the health of the world, nor independently from the context of inequality. Equally, our health cannot be seen independently from the political context. For example, Jean Twenge’s research shows how societies’ focus on attainment, appearance and material success goes hand in hand with the rise of mental health problems. We cannot be healthy in an unhealthy world. We cannot be free from anxiety when the world is in a threatening state.
Both mental and chronic somatic disorders, are on the rise, in adults and children. These disorders go hand in hand and exacerbate each other. The number of people needing mental health care is on the rise, as is the use of psychopharmacology. Burnout is on the rise, not only in clients, but also in their therapists.
We can control many risk factors in order to reduce our chances to develop certain diseases, but we cannot avoid the air we breathe. 90% of children worldwide are affected by air pollution, which will impact their mental and physical health. Soon one-fifth of the world population will need to flee because of climate change. And countries will close their borders. And trauma will rule, and be passed on to the next generations.
Perhaps it is in this context that third wave treatments, like mindfulness- and acceptance and commitment-based therapies, have become popular. They are more value based. What makes a life worth living? Meditation can help us realize the interdependence of all beings. Recognizing our suffering. Connecting ourselves with others who suffer too. Cultivating compassion for suffering. Reaching a deeper understanding of the causes of suffering. More process- than goal focused. Body and mind as mutually dependent.
There is no need to abolish cost-effective treatments that can fix problems like anxiety disorders. CBT is more effective for treating anxiety disorders than mindfulness, and the first-line treatment for these conditions. Nevertheless, third-wave treatments can help understand the context of the suffering we meet in our clients, and our own suffering, and help develop inner compassion. It can help see clients as a whole, within their context, their bodies, their families, their neighborhood, the food they eat, the air they breathe. Mindfulness can help see our own reactivity to our clients and their suffering. It can help us see more clearly generally.
INVITED ADDRESSES – Thursday 18th July – Saturday 20th July
Cognitive-Behavioral Approaches to Social Anxiety: Our Growing Edges
Debra Hope, University of Nebraska-Lincoln, USA
Fifty years ago David Watson and Ronald Friend published their seminal paper in Journal of Consulting and Clinical Psychology on the assessment of social anxiety that included two scales: the Social Avoidance and Distress Scale and the Fear of Negative Evaluation Scale. They identified that the experience of individuals with social anxiety is multifaceted, distinguishing between subjective emotional distress and behavioral avoidance of anxiety-provoking situations. Watson and Friend conceptualized fear of negative evaluation as a key motivation in social anxiety. This conceptual scheme has held up surprisingly well over five decades and will guide an exploration of contemporary work on social anxiety in adults. Technological advances such as ambulatory psychophysiological monitoring, computerized assessment of eye movement and other attentional processes, and apps to track location and emotion provide fine-grained data to test theories and refine interventions. Advances in theories of learning and emotion have transformed our understanding of cognitive behavioral treatment mechanisms. Finally, our growing understanding of the importance of cultural context challenges us to re-evaluate our approach to research, assessment, and intervention to meet the needs of all people. Watson and Friend could hardly have imagined the body of research on social anxiety that exists today. What questions might the next generation of clinical scientists tackle in a changing social world of emojis and online social relationships?
Debra A. Hope, Ph.D. is Aaron Douglas Professor Psychology at the University of Nebraska-Lincoln in the USA and past president of the Association of Behavioral and Cognitive Therapies (ABCT). She received her Ph.D. in 1990 under the direction of Richard G. Heimberg at State University of New York at Albany. Following her predoctoral clinical internship at the Medical College of Pennsylvania/Eastern Pennsylvania Psychiatric Institute, she joined the faculty at Nebraska. Prof. Hope has authored over 120 papers and four books. She is lead author with Richard Heimberg and Cindy Turk on the therapist guide and client workbook, Managing Social Anxiety: A Cognitive Behavioral Approach now in its 3rd edition, published by Oxford University Press in their Treatments That Work™ series. Prof Hope’s research has two primary foci: assessment and treatment of social anxiety, and reducing mental health impacts of marginalization stress for individuals who identify as transgender, gender diverse, lesbian, gay, bisexual, and/or queer. Across all of her work, the major theme has been to get the best psychological services to people who need them. This has included using telehealth to deliver services to rural areas, reducing therapist training burden through transdiagnostic approaches, and developing recommendations to reduce marginalization within treatments settings, a significant issue for transgender and gender diverse people. Prof. Hope maintains a small private practice. When she is not working, she enjoys life with her teenage daughter, two dogs, and a cat.
Bautista, C. & Hope, D. A. (2015). Fear of negative evaluation, social anxiety and positive and negative response to online social cues. Cognitive Therapy and Research, 39, 658-668.
Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33, 448-457.
Weiss, B. J., Hope, D. A. & Capozzoli, M. (2013) Heterocentric language in commonly used measures of social anxiety: Recommended alternate wording. Behavior Therapy. 44, 1-11
Personalizing Cognitive and Behavioural Treatments for Depression: The Crossroads of Basic and Applied Research
Kate Harkness, Queen’s University, Canada
Worldwide, major depressive disorder affects 300 million people and is the single largest contributor to global disability. The estimated cost of depression to the global economy is US$1 trillion per year, which exceeds the costs associated with cardiovascular disease or cancer. These costs are so high, in part, because of our failure as a field to get more people well and keep them well. Despite over 50 years of rigorous research in the development and implementation of cognitive, behavioural, and pharmacological treatments, remission rates are still unacceptably low and relapse and recurrence rates are unacceptably high. As such, depression remains for many people a chronic or highly recurrent disorder over the life-course. One of the greatest challenges in the treatment of depression is how to address the great heterogeneity of etiological factors, pathological markers, and syndromal expressions associated with the disorder. In this talk I will discuss results from basic research parsing this heterogeneity that are being used to inform a personalized approach to the treatment of depression. The promise of personalized medicine is to increase effectiveness and cost-effectiveness by offering treatment at the outset that has the highest likelihood of success, with the ultimate goal of preventing the enormous personal and societal burden of this disorder. Specifically, I will present data from several groups worldwide, including preliminary data from the Canadian Biomarker Integration Network in Depression (CAN-BIND), that are using markers at the neurobiological, psychological, and social-environmental levels of analysis to differentially predict response within and across psychological and somatic treatments. In doing so, I will also address how this research informs a deeper understanding of the nature of depression itself.
Kate L. Harkness is Professor of Psychology and Psychiatry, and Director of the Mood Research Laboratory and the Mood and Anxiety Assessment Service at Queen’s University in Kingston, Canada. She received her Ph.D. from the University of Oregon and completed her residency and post-doctoral fellowship at Western Psychiatric Institute and Clinic in Pittsburgh, Pennsylvania. Her research focuses on how stress and trauma in childhood lead to critical changes in biological and psychological processes that heighten vulnerability to depression. She is also working with the Canadian Biomarker Integration Network in Depression (CAN-BIND) to develop profiles of markers that predict response to cognitive-behavioural and somatic treatments.
Harkness, K. L., Bagby, R. M., & Kennedy, S. (2012). Childhood Maltreatment and Differential Treatment Response and Recurrence in Episodic Major Depression. Journal of Consulting and Clinical Psychology, 80, 342-353.
Lam, R. W., Milev, R., Rotzinger, S., Andreazza, A. C., Blier, P., Brenner, C.,…Harkness, K. L.,…Kennedy, S. H. (2016). Discovering biomarkers for antidepressant response: protocol from the Canadian biomarker integration network in depression (CAN-BIND) and clinical characteristics of the first patient cohort. BMC Psychiatry, 16, 105.
Adult Obsessive States
CBT for Body Dysmorphic Disorder: An Update on the State of the Art
Katharine Phillips, Weill Cornell Medical College, USA
Body dysmorphic disorder (BDD), impairing or distressing preoccupation with non-existent or slight defects in appearance, is a common and often-severe disorder. CBT that is individualized to BDD’s unique clinical features is the psychosocial treatment of choice for this condition. An increasing number of studies, including randomized controlled trials, indicate that CBT is efficacious for a majority of individuals with BDD and more consistently efficacious than other therapies.
This presentation will present data on the efficacy of CBT for BDD as well as recent data on predictors, moderators, and mechanisms of CBT outcomes. The treatment will also be described, which includes psychoeducation, case formulation, setting valued goals, motivational enhancement, cognitive restructuring, exposure and ritual prevention, mindfulness and attentional retraining, and advanced strategies to modify self-defeating assumptions about the importance of appearance and to enhance self-acceptance, self-esteem, and self-compassion. Optional modules target symptoms requiring specific strategies for those individuals with these symptoms, such as depression, skin picking, and surgery seeking. Modification of CBT strategies for youth will be described.
Clinicians commonly encounter a number of challenges when treating individuals with BDD. Frequently encountered challenges include poor or absent insight (i.e., delusional BDD beliefs); depressive symptoms, which can be severe; a desire for cosmetic procedures such as surgery or dermatologic treatment rather than CBT; low motivation for CBT; co-occurring substance use disorders; and suicidal ideation, which is common and can be severe. Strategies for approaching and overcoming these challenges will be discussed.
Finally, this presentation will discuss future research directions that have the potential to augment and improve CBT for BDD. They include enhancement of current CBT strategies as well as the development of treatments that target endophenotypes such as aberrations in visual processing and in cognitive and emotional processing.
Dr. Katharine Phillips is Professor of Psychiatry, DeWitt Wallace Senior Scholar, and Residency Research Director at Weill Cornell Medical College in New York City. She is also Attending Psychiatrist at New York-Presbyterian Hospital. In addition, she is Adjunct Professor of Psychiatry and Human Behavior at the Alpert Medical School of Brown University.
Dr. Phillips is internationally recognized for her pioneering research and clinical expertise in body dysmorphic disorder (BDD) and other obsessive-compulsive and related disorders. With Drs. Sabine Wilhelm and Gail Steketee, she developed and tested a cognitive-behavioral therapy for BDD in several studies funded by the National Institute of Mental Health. Her research on BDD was continuously funded by the National Institute of Mental Health for more than 20 years. Dr. Phillips has received numerous honors and awards for her research, research mentoring, and other academic accomplishments, including a Special Presidential Commendation from the American Psychiatric Association for her research accomplishments.
Dr. Phillips has more than 325 publications (scientific articles, book chapters, letters), and she has authored or edited 11 books. She has given more than 575 presentations in the U.S. and abroad.
Dr. Phillips is on the scientific advisory boards of the International OCD Foundation, the American Society of Clinical Psychopharmacology, and the Anxiety and Depression Association of America. She is on the Board of Directors of The Canadian Institute for Obsessive Compulsive Disorders. She also serves on a number of editorial boards. From 2007-2013, Dr. Phillips was Chair of the DSM-5 Work Group on Anxiety, Obsessive-Compulsive Spectrum, Post-Traumatic, and Dissociative Disorders and a member of the DSM-5 Task Force; she is currently a member of the DSM Review Committee for Internalizing Disorders. From 2002-2006, she chaired the National Institute of Mental Health’s Interventions Research Review Committee (Scientific Review Group). Dr. Phillips is a Fellow of the American College of Neuropsychopharmacology, a member of the American College of Psychiatrists, and a Distinguished Fellow of the American Psychiatric Association. She has repeatedly been included in Best Doctors in America, Castle Connolly’s America’s Top Doctors, Who’s Who in America, and Who’s Who in the World.
Phillips KA (editor). Body Dysmorphic Disorder: Advances in Research and Clinical Practice. New York, NY: Oxford University Press, 2017
Wilhelm S, Phillips KA, Fama JM, Greenberg JL, Steketee G. Modular cognitive-behavioral therapy for body dysmorphic disorder. Behavior Therapy 2011;42:624-633
Wilhelm S, Phillips KA, Steketee G. Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Treatment Manual. New York, NY: Guilford Press, 2013
How Well Do We Really Understand Compulsions? Implications for Theory and Treatment of Obsessive-Compulsive Disorder
Christine Purdon, University of Waterloo, USA
What do we really know about compulsions? Maybe not as much as we think we do, as there have been surprisingly few systematic studies of the phenomenology of compulsions. Interesting findings emerge when we ask people detailed questions about their compulsions as they are being performed. Using experimental, diary, and interview methods, we have explored such factors as how people with OCD frame the goal of their compulsions, what causes them to repeat the compulsion within an episode, and how they make the decision to terminate the compulsion. These data may help us understand the persistence of compulsions, and have implications for treatment that align well with current evidence-based approaches
The State of the Evidence on Psychotherapy for PTSD
Paula Schnurr, National Centre for PTSD, USA
This talk will review the evidence on psychotherapy for PTSD, using the 2017 PTSD Practice Guideline jointly issued by the US Department of Veterans Affairs and the Department of Defense as a platform for presenting the state of the science. The talk also will describe the key areas in which the science is emerging, such as medication-assisted psychotherapy, and suggest needed questions for research. In addition, the talk will include guidance about unique methodological considerations in the interpretation of the literature on psychotherapy.
Paula Schnurr is a psychologist and the Executive Director of the National Center for PTSD in the Department of Veterans Affairs. As one of the Center’s founding members in 1989, she was previously the Deputy Executive Director. She also is a Professor of Psychiatry at the Geisel School of Medicine and a Fellow of the American Psychological Association and the Association for Psychological Science. She recently served as a Co-Champion of the 2017 PTSD Practice Guideline issued by the Department of Veterans Affairs and the Department of Defense. She is Editor of the Clinician’s Trauma Update-Online, Past Present of the International Society for Traumatic Stress Studies, and former Editor-in-Chief of the Journal of Traumatic Stress. Her research focuses on the long-term effects of traumatic exposure, particularly on physical health and quality of life, and on the treatment of PTSD. She is an expert on methods of studying psychotherapy and has led a number of large multisite studies of treatment for PTSD.
Schnurr, P.P., Friedman, M.J., Engel, C.C., Foa, E.B., Shea, M.T., Chow, B.K., Thurston, V., Orsillo, S., Haug, R., Turner, C., & Bernardy, N. (2007). Cognitive-behavioral therapy for posttraumatic stress disorder in women: A randomized controlled trial. Journal of the American Medical Association, 297, 820-830. doi: 10.1001/jama.297.8.820
Watts, B.V., Schnurr, P.P., Mayo, L., Weeks, W., Young-Xu, Y., & Friedman, M.J. (2013). Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. Journal of Clinical Psychiatry, 74, 541-550. doi: 10.4088/JCP.12r08225
Basic Processes and Experimental Psychopathology
Neuroscience Driven Approaches to Cognitive and Behavioural Therapy for Anxiety and Depression
Michelle Craske, University of California, USA
The keynote will address ways in which advances in the neuroscience of defensive and appetitive motivational systems inform psychological treatment development. Within the defensive system, discussion will focus upon translation from the basic science of inhibitory extinction learning and inhibitory regulation for increasing response rates and reducing contextual return of fear. Latest data regarding pharmacological attenuation of contextual specificity will be presented. Within the appetitive system, discussion will focus upon evidence of deficits in neural and behavioural indices of reward sensitivity in depression and anxiety. Latest data regarding the outcomes from a new transdiagnostic treatment approach designed to enhance reward anticipation/motivation, reward attainment and reward learning will be presented.
Michelle G. Craske, Ph.D., is Distinguished Professor of Psychology, Psychiatry and Biobehavioral Sciences, Director of the Anxiety and Depression Research Center, and Associate Director of the Staglin Family Music Center for Behavioral and Brain Health, at the University of California, Los Angeles. She also directs the Innovative Treatment Network within the UCLA Depression Grand Challenge. She has published extensively in the area of fear, anxiety and depression. In particular, she investigates neurophysiological, environmental, cognitive and behavioral correlates and risk factors for anxiety and depression using longitudinal designs, fear extinction mechanisms and their neural underpinnings for exposure-based therapies for anxiety, reward sensitivity training for anhedonia, and implementation of treatments for anxiety and depression in non-research settings. She is Editor-in-Chief for Behaviour Research and Therapy. Dr. Craske received her BA Hons from the University of Tasmania and her Ph.D. from the University of British Columbia.
Craske, M.G., Hermans, D., & Vervliet, B. (2018). State of the art and future directions for extinction as a translational model for fear and anxiety. Philosophical Transactions B: Biological Sciences, 373(1742), 20170025. doi: 10.1098/rstb.2017.0025
Holmes, E.A., Ghaderi, A., Harmer, C.J., Ramchandani, P.G., Cuijpers, P., Morrison, A.P., Roiser, J.P., Bockting, C.L.H., O’Connor, R., Shafran, R., & Craske, M.G. (2018). The Lancet Psychiatry Commission on psychological treatments research in tomorrow’s science. The Lancet Psychiatry, 5(3), 237–286. doi: 10.1016/s2215-0366(17)30513-8
Craske, M.G., Meuret, A., Ritz, T., Treanor, M., & Dour, H. (2016). Treatment for anhedonia: a neuroscience driven approach. Depression and Anxiety, 33(10), 927-938.
Mental Imagery and Mental Health: CBT and Reflecting on Psychological TreatmentResearch
Emily Holmes, Karolinska Institutet, Sweden
Mental imagery provides an experience like perception in the absence of a percept, such as “seeing in our mind’s eye. Psychology is described as the science of mental life – and our inner images have a powerful impact on our emotion, motivation and behaviour. Although they can be fleeting and elusive, our research methods to investigate imagery are advancing. Better understanding mental imagery offers insights to improve our treatments. Intrusive image-based memories can “flash backwards” to past trauma, for example in post-traumatic stress disorder (PTSD). Mental images allow us to time travel and can also “flash forwards” to the future, such as those can occur related to suicide or in bipolar disorder. Indeed, intrusive, affect-laden mental images can cause distress across mental health disorders.
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 novel treatment development. Two main areas will be discussed – bipolar mood instability and intrusive images after trauma. First, we will discuss ideas using face-to-face psychological treatment techniques, with reference to imagery-focused cognitive therapy for mood instability in bipolar disorder, and developing a clinical manual (Holmes, Hales, Di Simplicio, & Young, 2019). Second, we will discuss more novel intervention approaches and the idea of working with intrusive images of trauma using concurrent tasks rather than talking therapy per se, while moving ideas between the lab and the clinic.
This is a “world congress of CBT” and to reach the scale of mental health “world-wide” we will need (among other things) mental health science to help us improve our treatments. A broader vision for science-informed psychological treatment innovation will be explored (Holmes, Ghaderi et al, 2018, Lancet Psychiatry1).
Holmes, Ghaderi, Harmer, Ramchandani, Cuijpers, Morrison, Roiser, Bockting, O’Connor, Shafran, Moulds, & Craske (2018). The Lancet Psychiatry Commission on Psychological Treatments Research. Lancet Psychiatry. 5(3). 237-86. http://dx.doi.org/10.1016/S2215-0366(17)30513-8
Beyond CBT: The Primacy of Emotional Change
Merel Kindt, University of Amsterdam, The Netherlands
Current psychological and pharmacological treatments for disorders of emotional memory only dampen the affective response while leaving the underlying fear memory intact. Under adverse circumstances, these original memories regain prominence, causing relapses in many patients. The (re)discovery in neuroscience that upon retrieval consolidated fear memories may return to a transient labile state, requiring a process of restabilisation in order to persist, offers a window of opportunity for modifying fear memories with amnestic agents. Observations of post-retrieval amnesia for learned fear in animals have generated a novel and influential hypothesis on the plasticity of memory, usually referred to as memory reconsolidation. The clinical potential of pharmacologically disrupting the process of memory reconsolidation has sparked a wave of interest into whether this phenomenon can also be demonstrated in humans, and ultimately harnessed for therapeutic purposes. Here I will outline how fundamental studies of learning and memory have moved the field forward from a focus on extinction learning to the prospect of a revolutionary treatment for emotional memory disorders. Instead of multiple or prolonged sessions of cognitive behavioural treatment or daily drug intake with a gradual decline of symptoms, it involves one single instance of treatment that leads to a sudden – albeit delayed – decline in fear. The reconsolidation intervention is furthermore in stark contrast with a fundamental tenet of CBT: a cognitive change is not required for the reconsolidation intervention, and when a cognitive change already takes place during the reconsolidation intervention, this actually poses a boundary condition for the treatment. The reconsolidation intervention also represents a shift in the use of pharmacological agents to alleviate symptoms. It involves just one single administration of a very common drug (i.e., propranolol) given in conjunction with memory retrieval (i.e., brief exposure) during a specific time window. Even though basic science in animals and humans suggests that we are on the verge of a breakthrough in fundamentally changing emotional memories, the necessary and boundary conditions for targeting and disrupting memory reconsolidation in clinical practice are largely unknown. There is likely no universally effective retrieval procedure for clinically significant emotional memories to trigger memory reconsolidation, and the impact of subtle boundary conditions observed in basic science compounds this issue. Understanding the critical conditions to trigger memory reconsolidation in clinical practice is one of the greatest challenges to be addressed before we can witness a paradigm shift in the treatment of emotional memory disorders.
Merel Kindt (1967) is Professor of Experimental Clinical Psychology at the University of Amsterdam. Her mission is to understand mechanisms of change, and to build on behavioural neuroscience in order to shape clinical interventions. In 2008, she started an innovative research programme on the plasticity of fear memory, which challenged the prevailing hypothesis that emotional memories are fixated in the physical architecture of the brain. She has used and developed a vast array of experimental methods to study the formation, consolidation and plasticity of emotional memory, including behavioural and neurobiological methods (e.g., adaptation of the classical fear conditioning paradigm), cognitive methods (e.g., information processing biases, meta-memory in obsessive compulsive disorder and posttraumatic stress disorder), and neural methods (e.g., neural pattern analyses of fear learning and memory). Over the last decade, she showed and replicated that the emotional expression of fear memories can be neutralized in humans (e.g., Nature Neuroscience, 2009; Nature Communications, 2018), and which conditions are essential for this to occur (Science, 2013). The potential of her research programme lies in the bidirectional translational approach. It builds on fundamental insights from animal and human neuroscience literature, as well as clinical observations. These insights and observations provide operational tools which can be used to test novel hypotheses at different levels of analysis: from basic science to clinical applications, and vice versa. Kindt recently designed a new memory reconsolidation intervention in which she translated fundamental insights on the plasticity of fear memory to a subclinical population (Biological Psychiatry, 2015). Prof. Pitman from Harvard lauded her research in his commentary ‘Harnessing reconsolidation to treat mental disorders’ (Biological Psychiatry, 2015) by stating: “An appeal of the line of research taken by Kindt and colleagues is that it is truly translational. Translational is a word often invoked but not often realized in psychiatric research. Work in Kindt’s laboratory epitomizes translational research. It has built on basic animal findings regarding the labile nature of memory and applied these findings first to experiments in normal human subjects and subsequently in this impressive article to a subclinical condition. The applicability of reconsolidation blockade and memory updating to full-blown mental disorders remains to be seen, but in light of this article, the prospects seem more promising than ever.”
Elsey, J.W.B., van Ast, A., & Kindt, M. (2018). Human memory reconsolidation: A guiding framework and critical review of the evidence. Psychological Bulletin, 144, 797-848.
Kindt, M. (2018). The surprising subtleties of changing fear memory: a challenge for translational science. Phil. Trans. R. Soc. B, 373(1742), 20170033.
Kindt, M., & Soeter, M. (2018). Pharmacologically induced amnesia for learned fear is time and sleep dependent. Nature Communications, 9:1316.
Cognitive Behavioural Therapy for Irritable Bowel Syndrome: The 18-year Journey from Theory to Implementation
Rona Moss-Morris, King’s College, London, UK
IBS is a chronic and relapsing gastrointestinal disorder that affects 10 – 22% of the population. The primary symptom is abdominal pain associated with disordered bowel habit (constipation and/or diarrhoea) and relieved by defaecation. Although there is no clearly observed pathology to the bowel, IBS can significantly affect quality of life and there is a high incidence of comorbid anxiety and depression. The costs to the health care system are substantial with no clear standardised, evidenced based treatment for IBS. Many patients continue to suffer ongoing symptoms and related disability despite being offered first line medications such as antispasmodics and fibre products. Randomised controlled trials suggest cognitive behavioural therapy (CBT) is a promising treatment for IBS, but CBT protocols and results vary across studies, and questions remain over optimum modes of delivery, adherence to therapy and longer-term outcomes. To date, CBT is not offered routinely as a treatment for people with IBS.
In this keynote, I will use the example of our work on irritable bowel syndrome (IBS) to track the journey from research to beginning the work necessary to embed IBS specific CBT into routine clinical care. I will show how we have used the Medical Research Councils’ framework for developing complex interventions to develop an evidenced based CBT protocol for IBS. The first phase of the work involved developing an empirically based theory to explain perpetuation of symptoms and disability in IBS drawing from Leventhal’s common-sense model of illness and cognitive behavioural theories. In the second phase we used this model to develop an IBS specific therapist supported cognitive behavioural self-management approach. In phase three, we evaluated this intervention in a pilot RCT comparing CBT self-management for IBS to standard medical care. In phase 4 we developed and piloted a guided self-management web-based version of this treatment (Regul8) to make it more accessible to patients. The final phase of this work was the ACTIB trial where we compared the clinical and cost effectiveness of web-based CBT and therapist delivered CBT over the telephone with treatment as usual. There were 558 patients randomised to the three arms in this trial and patients were followed up to one-year post randomisation. We just completed a further 24 months follow up of the trial and a detailed qualitative and quantitative process analysis to test our original theory and to work out who responds best to treatment and why. I will use these data to argue that our CBT protocol primarily treats IBS symptom severity and related disability through specified cognitive behavioural mechanisms, and that improvements in anxiety and depression are secondary to improvements in symptoms.
Finally, I will detail our current work which has involved engaging with national training programmes and the national health service to ensure the therapy is rolled-out nationally and a commercial partner to work towards roll-out worldwide.
Rona Moss-Morris is Professor of Psychology as Applied to Medicine. She is Head of the Health Psychology Section at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. She is a Fellow of Academy of Social Sciences, was awarded the British Psychological Society Division of Health Psychology’s Outstanding Contribution to Research Award in 2015 and the Multiple Sclerosis Society MS Research of the Year in 2014.
She was National Advisor to NHS England for Increasing Access to Psychological Therapies for People with Long Term Conditions from 2011-2016. She was Editor-in-Chief of Psychology and Health from 2006-2010 and is an incoming Editor of Health Psychology Review.
She has been researching psychological factors that affect symptom experience and adjusting to long term conditions for the past 20 years. This research has been used to design theory based cognitive behavioural interventions, including web-based interventions, for a range of patient groups including multiple sclerosis and irritable bowel syndrome. Randomised controlled trials to test the clinical and cost effectiveness of these interventions form a key component of her research including training and supervision of therapists in these studies.
She has substantial curriculum design experience, including developing clinical competences. She teaches a wide range of health care professionals in her research related subject areas. Her teaching includes running CBT training workshops for people with long term conditions both nationally and internationally. More recently her focus is on rolling out interventions into real world practice.
Everitt, H. Landau, S. Little, P. Bishop, F.L. McCrone, P. O’Reilly, G. Coleman, N. Logan, R. Chalder, T. Moss-Morris, R. (2015). Assessing Cognitive behavioural Therapy in Irritable Bowel (ACTIB): protocol for a randomised controlled trial of clinical-effectiveness and cost-effectiveness of therapist delivered cognitive behavioural therapy and web-based self-management in irritable bowel syndrome in adults. BMJ Open 2015; 5(7) doi:10.1136/bmjopen-2015-
Moss-Morris, R. Bogalo, L. Didsbury, L.P. and Spence, M.J. (2010). A randomised controlled trial of a cognitive behavioural therapy based self-management intervention for irritable bowel syndrome (IBS) in primary care. Psychological Medicine. 40(1) 85-94. doi:10.1017/S0033291709990195.
Spence, M. and Moss-Morris, R. (2007). The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of gastroenteritis patients. GUT. 56 (8) 1066-1071.
Self-reported Symptoms and the Body: A New Perspective on their Relationship
Omer van den Bergh, University of Leuven, Belgium
How do you feel? This simple question is asked by doctors, family and friends when you feel ill. But how does the experience of symptoms come about and what do symptoms tell about actual bodily dysfunction? Afferent information from peripheral physiology is an important source, but a variety of interoceptive processes can make the relationship between symptoms and physiological dysfunction vary from almost perfect to zero. When the latter happens, which is all too often, symptoms cannot be related to physiological dysfunction, frustrating both the doctor and the patient and leading to excessive health care consumption. Interestingly, the probability of developing such symptoms is importantly elevated in persons characterized by (facets of) negative affectivity.
We will review evidence showing when symptoms are related to peripheral physiology and when and why they are not. Experimental studies show that symptoms and physiological dysfunction can be easily uncoupled and that affective sources of interoceptive input often overrule somatic sources to determine symptoms. Convergent results question modal models that were previously used to understand so-called medically unexplained symptoms and somatization and prompt a new way to understand how symptoms relate to peripheral bodily dysfunction.
Much as in visual perception where an unconscious, automatic and compelling inference process often uses non-given information to construct a meaningful percept (cfr. visual illusions), symptom perception is conceived of as a dynamic constructive process balancing afferent peripheral input and information generated by the brain: under some conditions, the eventual percept of a symptom closely reflects the afferent input, while in other conditions it may more closely reflect (implicit) prior expectations. In both cases, however, symptoms rely on the same constructive mechanisms and have the same phenomenal quality of “trueness”. This view suggests that current clinical interventions in somatization should broaden their scope. Rather than mainly focusing on treating symptom-related distress (worrying, rumination, attentional and interpretation biases), interventions are needed that may change the perceptual processes themselves that lead to symptoms unrelated to bodily dysfunction.
Omer Van den Bergh obtained a Ph.D. in Psychology at the Laboratory of Experimental Psychology, University of Leuven (1986), followed a postdoc training at the NIMH Center for the Study of Attention and Emotion (Prof. Dr. P.J. Lang) at the University of Florida (1986) and a postgraduate training in cognitive behavior therapy. He is supervisor of the Flemish Association for Behavior Therapy. Since 1988, he teaches health psychology at the University of Leuven to students of psychology, medicine and physical education. He was associate editor of “Biological Psychology” between 1999 and 2015, and former president of the International Society for the Advancement of Respiratory Psychophysiology (ISARP). He is founder and was director of the Research Group on Health Psychology at the University of Leuven from 1998 till 2015, and co-founder of a spinoff company of the University of Leuven providing services to prevent stress and improve well-being in organisations. Since 2016, he is ombudsperson of the KU Leuven, and emeritus professor since October 2018.
Omer Van den Bergh is expert in the broad area of the relationship between health and behaviour. Specific key words in his work are subjective health and respiratory psychophysiology in response to stress and aversive somatic experiences. He is especially inspired by learning psychology and symptom perception theory to investigate the links among these issues. The 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.
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
Van den Bergh, O., Brown, R.J., Petersen, S., & Witthöft, M. (2017). Idiopathic environmental illnesses: A comprehensive model. Clinical Psychological Science, 5 (3), 551-567. doi.org/10.1177/2167702617693327.
Henningsen, P., Gündel, H., Kop, W.J., Löwe, B., Martin, A., Rief, W., Rosmalen, J., Schröder, A, van der Feltz-Cornelis, C., & Van den Bergh, O. (2018). Persistent physical symptoms as perceptual dysregulation: a neuropsychobehavioral model and its clinical implication. Psychosomatic Medicine, 80, 422-431. doi: 10.1097/PSY.0000000000000588.
Child and Adolescent Mental Health
Improving CBT Interventions for Young people with Anxiety Disorders
Jennie Hudson, Macquarie University, Australia
Anxiety Disorders are the most common mental disorders and are the first to appear, more often than not in childhood. We have made considerable progress over the past 25 years showing, most notably, that cognitive behavioural therapy (CBT) is an effective treatment for childhood anxiety disorders. With a remission rate of around 60%, we do not yet know what modifications are needed to extend the efficacy of treatment to all children. Non-responders continue to be at risk for mental health problems across the lifespan, and thus the importance of improving treatments cannot be overstated. This talk will highlight what we know about predictors and moderators of treatment and explore possible models for improving mental health care for this often overlooked group of children.
Professor Jennie Hudson is the Director of the Centre for Emotional Health in the Department of Psychology, Macquarie University and is a Fellow of the Academy of Social Sciences of Australia. Jennie’s research focuses on understanding the factors that contribute to children’s emotional health and working to improve the services available to children experiencing anxiety and other emotional disorders. Hudson co-authored the book “Treating anxious children: An evidence-based approach” (2000) and edited “Psychopathology and the Family” (2006). She is an Associate Editor for the Journal of Abnormal Child Psychology and serves on the editorial board of a number of international journals including Journal of Clinical Child and Adolescent Psychology and Behaviour Research and Therapy. She is also has been elected to the Australian Research Council, College of Experts.
Hudson, J. L., Keers, R., Roberts, S., Coleman, J. R., Breen, G., Arendt, K., Bögels S., Cooper P., Creswell C., Hartman C., Heiervang ER., Hötzel, K., In-Albon, T., Lavallee, K., Lyneham, H. J., Marin, C. E., McKinnon, A., Meiser-Stedman, R., Morris, T., Nauta, M., Rapee, R. M., Schneider, S., Schneider, S. C., Silverman, W. K., Thastum, M., Thirlwall, K., Waite, P., Wergeland, G. J., Lester, K. J., Eley, T. C. (2015). Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (gxt) Study. Journal of the American Academy of Child & Adolescent Psychiatry, 54 (6) 454-463.
Hudson, J. L., Rapee, R. M., Lyneham, H. J., McLellan, L. F., Wuthrich, V. M., & Schniering, C. A. (2015). Comparing outcomes for children with different anxiety disorders following cognitive behavioural therapy. Behaviour research and therapy, 72, 30-37.
James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2013). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of systematic reviews, (6).
Meeting the Needs of Clients with ASD and Neurodevelopmental Disorders: Mindfulness and Other Modifications to Enhance CBT Effectiveness
Carla Mazefsky, University of Pittsburgh School of Medicine, USA
Children and adults with autism spectrum disorder (ASD) and other intellectual and developmental disabilities (IDD) often present for treatment for emotional and behavioural problems, such as depression, anxiety, meltdowns, poor stress management, or aggression. In ASD, there have been several randomized controlled trials to investigate the efficacy of cognitive-behavioural therapy for decreasing anxiety in particular, and cognitive-behavioural therapy is now considered an evidence-based treatment for ASD. Nonetheless, the effect sizes for cognitive-behavioural therapy tend to be lower in ASD and other neurodevelopmental disorders than general child or adult populations, and there is limited research on the effectiveness of CBT for therapeutic targets other than anxiety. There is a smaller, but growing, body of literature suggesting that the use of mindfulness-based approaches may also be promising for a broader range of emotional treatment targets. There is also a growing appreciation for the role that emotion regulation plays in the poor psychiatric and behavioural outcomes in ASD and other neurodevelopmental disorders. Therefore, some new treatments to improve emotion regulation are being designed and tested in the hopes that improving emotion regulation will lead to better functioning across a wide range of manifestations of emotional and behavioural problems. This talk will describe the latest research on emotion dysregulation in autism spectrum disorder and other neurodevelopmental disorders. Both evidence-based assessment and treatment approaches will be covered, including an overview of the Emotion Dysregulation Inventory validated for developmental disabilities. Commonly employed modifications for therapy with clients with neurodevelopmental disorders will be described. Finally, a new intervention designed for ASD and other neurodevelopmental disorders, called the Emotion Awareness and Skills Enhancement (EASE) Program will be introduced. EASE is a 16-week individual therapy program designed to improve emotion regulation. EASE provides an example of a treatment that heavily emphasizes mindfulness while still incorporating some of the core components of CBT. Further, because EASE was designed for use with clients with neurodevelopmental disorders, it is illustrative of common modifications to therapy delivery that are thought to be useful when working with populations with neurodevelopmental disorders. The process of EASE’s development will be described, results of the open trial of EASE will be presented, and preliminary data from the on-going randomized controlled trial comparing EASE to individual supportive therapy will be shared.
Dr. Carla Mazefsky earned her degree in clinical psychology from Virginia Commonwealth University following completion of her pre-doctoral internship at Brown University. She is currently an Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine. She is Co-Director of the Center for Autism Research and Director of the Regulation of Emotion in ASD Adults, Children, and Teens (REAACT) Program. Her research involves investigations of mechanisms underlying emotion regulation, psychiatric and behavioural problems associated with emotion regulation in ASD, and the development of new assessment and treatment approaches. Her current studies span the age ranges of school-aged through adults and include both those who are severely affected (e.g., nonverbal, have intellectual disability, and severe aggression or self-injury) and individuals who are verbal and have average or better cognitive ability. She is co-author of the Emotion Awareness and Skills Enhancement (EASE) Program and developer of the Emotion Dysregulation Inventory. Dr. Mazefsky has been recognized by the International Society for Autism Research with the Slifka-Ritvo Award for Innovation in Autism Research for her measure development work. She is an Associate Editor for the Journal of Autism and Developmental Disorders, and is Co-Editor of the soon-to-be-published Oxford Handbook of Co-Occurring Psychiatric Conditions in Autism.
Conner, C. M., White, S. W., Beck, K. B., Golt, J., Smith, I. C., & Mazefsky, C. A. (2018). Improving emotion regulation ability in autism: The Emotional Awareness and Skills Enhancement (EASE) program. Autism, Advance Online Publication. https://doi.org/10.1177/1362361318810709
Mazefsky, C. A., Yu, L., White, S. W., Siegel, M., & Pilkonis, P. A. (2018). The emotion dysregulation inventory: Psychometric properties and item response theory calibration in an autism spectrum disorder sample. Autism Research, 11, 928-941. https://doi.org/10.1002/aur.1947
Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., & White, S. W. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 679-688. doi: 10.1016/j.jaac.2013.05.006
40 Incredible Years Developing the IY Programs: Where we’ve been and where to go next?
Carolyn Webster-Stratton, University of Washington
As many as eight percent of young children are highly aggressive, oppositional, diagnosed with ADHD, or have difficult temperaments. These children are often challenging to parent or teach. Long-term studies show that such children have a higher risk of developing conduct disorders that lead to school dropout, delinquency, violence, and substance abuse. Because conduct disorders are the most expensive mental health disorder in children, this is a problem of public health importance. Identifying and helping these children and their families and teachers is imperative. Dr. Carolyn Webster-Stratton, Professor Emeritus from the University of Washington has spent 35 years researching ways to help prevent and treat behavior problems in young children, as well as developing and researching programs to promote children’s social and emotional competence and academic readiness.
During her presentation she will talk about what led her to develop the Incredible Years Programs including her personal experiences, important mentors, decision making regarding populations to address, content to include, use of technology, and key therapeutic methods and processes. She will briefly summarize over 30 years of her randomized control group trials regarding what methods, processes and participants are needed to bring about parent, teacher and child interaction change. She will describe some of the IY parent, teacher and child programs and show video examples of some of these programs to demonstrate how they work. Additionally, she will show examples of some of her newer programs. Finally, she will talk about the implementation process of promoting program fidelity, including where the program is currently being used, what has been learned so far with these IY evidence based programs and where the research needs to go next.
Carolyn Webster-Stratton is Professor Emeritus and Founder of the Parenting Clinic at the University of Washington School of Nursing. She is a licensed clinical psychologist and nurse-practitioner, and a leading expert on parenting, family therapy, and promoting young children’s social, emotional and a academic competence at home and at school. She has published books for professionals, parents and children and conducted more than a dozen randomized control group research trials and numerous publications concerning prevention and treatment programs for children with oppositional defiant disorder and ADHD. She has had extensive clinical and research experience in helping teachers and families with difficult children with the goal of reducing conduct disorders and strengthening social and emotional competence and school readiness skills. She has produced the Incredible Years®: Parents, Teachers and Children training series, which consists of over 70 training DVDs to be used in a collaborative way by therapists, pediatricians, and trained group leaders with teachers, parents and children. These programs have been translated into 10 languages. Currently there are 8 accredited trainers, 75 mentors and 110 peer coaches providing training and support in 23 countries. She has received numerous awards including National Mental Health Lela Rowland Prevention Award for her interventions with families; the prestigious National Mental Health Research Scientist Award; the 2013 Dale Richmond/Justin Coleman Lectureship Award from the American Academy of Pediatrics; 2017 Trailblazer Award from Association for Behavioral and Cognitive Therapies Parenting and Family Special Interest Group; 2018 Distinguished Career Award from APA Society of Clinical and Adolescent Psychology, and a Doctor Honoris Causa in 2013 from the Université de Sherbrooke.
Webster-Stratton, C. and J. Reid, The Incredible Years Parents, Teachers and Children Training Series: A Multifaceted Treatment Approach for Young Children with Conduct Problems in Evidence-based psychotherapies for children and adolescents, 3rd edition, A.E. Kazdin and J.R. Weisz, Editors. 2017, Guildford Publications New York.
Webster-Stratton, C. and T. Bywater, The Incredible Years Series: An Internationally Evidence-based Multi-model Approach to Enhancing Child Outcomes, in APA Handbook of Contemporary Family Psychology, B. Fiese, Editor. 2019.
Webster-Stratton, C. and K.P. McCoy, Bringing The Incredible Years programs to scale, in The science and art, of program dissemination: Strategies, successes, and challenges. New Directions for Child and Adolescent Development, K.P. McCoy and A. Dianna, Editors. 2015. p. 81-95
Cross Cultural and Global Issues
Distinctive Aspects in CBT in Brazil: How Cultural Aspects Impact Training and Clinical Practice
Carmem Beatriz Neufeld, University of Sao Paolo, Brazil
The CBT in Brazil has achieved greater highlight in the last few years, but it has still come up against some limits. According to the Ministry of Education, there are currently more than 470 psychology courses in the country and, based on the size and population distribution, they are spread unevenly across the country. A research has mapped the CBT teaching in the country pointed to the growth of the frequency of this content in universities, especially in the south, southeast and northeast regions. Despite this, there is still a predominance of more traditional approaches to psychology such as psychoanalysis and humanism in undergraduate courses. Another limiting aspect is the technicist model of teaching in Brazil, which minimizes the critical construction in the therapist’s training, favoring the application of protocols and techniques as a mere reproduction without considering the individualized demand. Another characteristic for the therapists’ training in the country is the increase in the offer of lato sensu postgraduate courses for this purpose, however, as well as in undergraduate courses, there is also a lack of standardization in the teaching of clinical competences in CBT. A national study pointed to differences in 20 evaluated courses, including whether or not they offer clinical supervision and its frequency, the number of hours required for clinical practice and supervision, the organization of content and activities for clinical development. In addition, in Brazil there is no evaluation culture, generating a strangeness on the part of supervisors and trainees in objectively evaluating the teaching process, the development of the therapist’s competences, the therapeutic process, as well as the final results. There is no culture of using already consolidated educational strategies such as session recording and the use of scales. For example, no educational institution, whether undergraduate or postgraduate, has reported using the CTS-R or other competency measurement scale. There are few reports in the national literature about this type of educational activity, being isolated actions of researchers and specific professionals. In an initial study, a focus group was conducted with eight renowned CBT professors from all regions of Brazil. Among several aspects, some concerns have been raised and are directly related to our culture. For example, it has been pointed out that Socratic Questioning is particularly difficult for beginning therapists because of the cultural practice of counseling and the strong dissemination of unstructured therapies in the country. This cultural aspect also directly impacts the definition of therapeutic goals, considered a skill to be improved in the teaching of Brazilian therapists. Finally, the use of humor was viewed with fear, since its lability and ease of being misinterpreted is great in face of the cultural and interpersonal diversities in the country. There is a need for more in-depth research on this subject since the studies are still initial and there is a lack of information
Carmen Beatriz Neufeld is Head of the Cognitive Behavioral Intervention and Research Laboratory – LaPICC-USP, Associate Professor at the Department of Psychology, at the Faculty of Philosophy, Sciences and Languages of Ribeirão Preto, at the University of São Paulo. She is Vice-President of the Latin-American Association of Cognitive and Behavioral Psychotherapies – ALAPCCO (2015-2018)
Research scholarship by the Brazilian National Council for Scientific and Technological Development
Integrating CBT, Schema Therapy and Mindfulness into a Trans-Diagnostic Self-Healing Programme: An Asian Perspective
Younghee Choi, Inje University, South Korea
As the Fellow of ACT (Academy of Cognitive Therapy) and ISST (International Society of Schema Therapy) certified Schema therapist, the presenter tried to develop Trans-diagnostic Integrated Psychotherapy. The presenter started from the cognitive model based on Aaron Beck’s cognitive theory and tried to assimilate different theories and techniques among the existing evidence-based psychotherapies.
With cognitive behavioral therapy, several thousands of my patients learned how to solve their own problems as the self-therapist, but still there were many patients do not respond well to CBT and we call them treatment-resistant cases who usually have co-morbid problems, especially personality disorders.
Studies about personality disorders showed that unique schemas were developed from the combination of childhood experiences and emotional temperaments. Contents of these schemas (core beliefs) produce automatic thoughts in specific situation and these automatic thoughts were not responding well to CBT. That was why schema focused therapy was developed, especially by Jeffrey Young. With Schema Therapy, the presenter could help more patients with Personality Disorder who did not respond well with CBT.
Even though with powerful effectiveness of schema therapy, the presenter still needed something more to help patients who were suffering from unchangeable problems. Naturally, the presenter found a “third wave” of cognitive and behavioral therapies, including ACT (Acceptance and Commitment Therapy) and MBCT (Mindfulness Based Cognitive therapy), which expanded the concepts to other disorders and/or added novel components and mindfulness exercises. The presenter owed a lot from Jon Kabat Zinn for learning mindfulness.
Through this lecture, the presenter will introduce CASH (Change and Acceptance Self Healing) program which is based on the integration of CBT, schema therapy, and mindfulness approaches and show the effectiveness of CASH program with the result of investigated symptoms of depression and anxiety along with the changeability of thoughts and attitudes after completion of 6-sessions of CASH program.
In the heart of the entire group format therapy in Mettaa Institute includes 6 weeks of CASH program. After patients completed group CBT, patients are re-evaluated and much improved patients who acquired various therapeutic skills would stop therapy. Patients who needed more treatments would enter the individual sessions of schema therapy that would last one to three years with weekly or bi-weekly sessions. Some patients needed mindfulness training would receive 8 weeks of Vipassana Meditation class.
For the past 30 years, I worked with my patients, students, colleagues, and supervisors. When I had encountered obstacles, those were challenging problems that I need to find out solutions.
Transcultural Aspects of Cognitive and Behavioural Therapy: A Moroccan example
Nadia Kadri, Institut Marocain de Thérapie Cognitive et Comportementale, Morocco
The United Nations agency UNESCO has defined culture as the “set of distinctive spiritual, material, intellectual, and emotional features of society or a social group, and that it encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs.”
However, as a therapist, in our daily clinical practice we notice that:
- patients from different cultures are sometimes closer by their personal specificities than patients from the same culture.
- the therapeutic relationship between patient and therapist transcends cultural specificities.
- the biological and psychological fundamentals transcend cultural particularities.
This presentation will address the following topics:
Culture, it’s components and specificities on Moroccan culture with their implication on mental health, its trouble and care. This will be based on studies conducted in the field. CBT as an empirical, experimental model that has been developed in Western culture and is spreading throughout the world. This fact raises the following questions, especially in the non-Western world:
– what cultural factors require management of CBT?
– what are the transcultural fundamentals of CBT?
– how to integrate cultural factors in CBT?
In order to propose answers to these questions, we present the results of a study carried out over several consecutive years concerning the CBT practice of Moroccan therapists.
Nadia Kadri is Currently psychiatrist, psychotherapist and sexologist.Founder, teacher and head of the Moroccan Institute of Cognitive and Behavioral Therapy, Casablanca.Teacher at the Faculty of Medicine, Mohamed VI University of Health Sciences. Casablanca. Professor of Psychiatry. Founder at the Faculty of Medicine, University Hassan II Casablanca
Former President of the Moroccan Society of Psychiatry,President of the Moroccan University Association of Sexual Health, Active member of the Moroccan Association of Behavioral and Cognitive Therapies which is recognized by the European Association for Behavioral and Cognitive Therapies (EABCT) as an Affiliate Member. President until May 2018. Currently, she is the General Secretary.
Former Head of the Research Laboratory in Mental Health, Cognition and Psychopathology, Hassan II University. Casablanca. Morocco.
Her research, published nationally and internationally, focuses on epidemiological studies in Mental Health (1st National Study on the prevalence of Mental Disorders in Morocco), Perinatality and Mental Health of Women, Sexuality and its disorders, Ramadan and Mental Health, Anxiety Disorders, Mood Disorders, Addictions, Cognitive and Behavioral Therapies and Stigma.
She has published more than one hundred scientific articles or book chapters in Arabic, French and English as well as several national and international books. Among the books published in Morocco by Editions Le Fennec: Manual d’éduation sexuelle (2009), دليل التربية الجنسية, guide de l’anxieux (2011), Affirmation de soi et Santé Mentale (2013), Estime de soi (2015), le couple (2018).
Pros and Cons of Transdiagnostic Thinking: Examples from the Eating Disorder Field
Kelly Bemis Vitousek, University of Hawaii
Transdiagnostic principles are especially salient in the eating disorder (ED) field. Fairburn’s enhanced cognitive-behavioral treatment for EDs (CBT-E; Fairburn, 2008; Fairburn et al., 2003) was among the first protocols to specify a common therapeutic approach for distinct diagnoses, based on the identification of shared maintaining mechanisms in anorexia nervosa (AN) and bulimia nervosa (BN). Moreover, symptom overlap between the EDs and other psychiatric disorders has prompted numerous efforts to import established treatment methods that address different elements of the complex symptom picture these patients present. Although the defining features of AN and BN are relatively circumscribed, EDs share space with virtually every category in the classification system, including the fear and avoidance characteristic of anxiety disorders, marked mood disturbance, obsessionality and ritualistic behavior, “addictive” phenomena, autistic spectrum features, and near-delusional thinking.
At the same time, the history of transdiagnostic efforts in the ED field illustrates the limits of selecting treatment approaches on the basis of symptom similarity. Interventions transferred from other conditions yield relentlessly disappointing results when applied to EDs. Most individuals with AN are depressed, yet antidepressant medication has no discernible benefits; although fear and avoidance are prominent, neither pharmacological nor psychological treatments targeting these elements have so far produced remission rates comparable to those attained for most anxiety disorders.
Recent – and long overdue – attempts to incorporate advances in exposure therapy into CBT for EDs provide an instructive example of both the promise and perils of borrowing broadly effective techniques from other specialty areas. Although core exposure principles are likely to prove robust, it is crucial that we attend to the distinctive functional relationships that maintain avoidant and safety-seeking behaviors in the context of EDs. These disorder-specific determinants, including starvation effects and the fear of becoming less afraid, have important implications for the timing, targets, and techniques of exposure.
With particular reference to AN, transdiagnostic thinking may also constrain our understanding to the extent that it encourages us to seek shared mechanisms and convergent change principles solely within the bounds of the psychiatric classification system. Some of the most striking and persistently puzzling features of AN are seldom associated with other forms of psychopathology. More apt parallels can be located in extreme forms of overvalued, highly effortful pursuits in non-clinical populations. Continuing efforts to decode the disorder more accurately and treat it more effectively may be enhanced by transcending divisions between clinical and normal phenomena, as well as between discrete diagnostic categories.
Kelly Bemis Vitousek is an Associate Professor of Psychology at the University of Hawai’i, where she serves as Co-Director of the Center for Cognitive Behavior Therapy and Director of the Eating Disorder Program. Her interests include motivational issues in the treatment of eating disorders, CBT for anorexia nervosa, and patterns of valued, effortful behavior in non-clinical populations, including high-altitude mountain climbers, competitive birders, and practitioners of calorie restriction for longevity. She has served on the editorial boards of seven journals, and received awards from national and international organizations for clinical and training contributions.
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509-528.
Murray, S. B., Treanor, M., Liao, B., Loeb, K. L., Griffiths, S., & Le Grange, D.
(2016). Extinction theory and anorexia nervosa: Deepening therapeutic mechanisms. Behaviour Research and Therapy, 87, 1-10.
Intellectual and Developmental Disabilities
The Early Emergence of Mental Health Inequalities in Children with Intellectual Disabilities: Implications for Intervention and Family Support
Richard Hastings, University of Warwick, UK
Children and adolescents with intellectual disabilities are 4-5 times more likely than children without intellectual disabilities to have mental health problems. At a population level, these children account for a large minority of all cases of mental health problems in young people. Thus, children with intellectual disabilities are a priority for mental health policy and interventions and we need to consider why they are at risk for mental health problems and what can be done to address this mental health inequality.
Research data suggest that an increased risk for mental health problems emerges early in the lives of children with intellectual disability – at least by age 5. Also, environmental, social and psychological risk factors for mental health problems in children are more likely to affect children with intellectual disability.
The main focus of this presentation is to present research, including new data, on the early development of behavioural and emotional problems in children with intellectual disability. In particular, family poverty, parental mental health, and parenting play a role in the development of mental health problems in children with intellectual disability. Implications of these research findings for early mental health intervention and support for families will be discussed.
Richard Hastings is Professor of Psychology and Education and the Cerebra Chair of Family Research at the University of Warwick The majority of his research focuses on the psychological needs of children and adults with intellectual disabilities and/or autism and their family members (including parents and siblings). Richard is a Fellow of the Academy of Social Sciences, the British Psychological Society, and the International Association for the Scientific Study of Intellectual and Developmental Disabilities. In his research and policy work, he collaborates closely in particular with families and disability NGOs. Richard has published over 300 research papers mainly in the field of intellectual disability/autism, and is the Editor in Chief of the Journal of Intellectual Disability Research.
Hastings, R. P. (2016). Do children with intellectual and developmental disabilities have a negative impact on other family members? The case for rejecting a negative narrative. International Review of Research in Developmental Disabilities, 50, 165-194.
Totsika, V., Hastings, R. P., Vagenas, D., & Emerson, E. (2014). Parenting and the behavior problems of young children with an intellectual disability: Concurrent and longitudinal relationships in a population-based study. American Journal on Intellectual and Developmental Disabilities, 119, 422-435.
Totsika, V., Hastings, R. P., Emerson, E., Berridge, D. M., & Lancaster, G. A. (2011). Behavior problems at five years of age and maternal mental health in autism and intellectual disability. Journal of Abnormal Child Psychology, 39, 1137-1147.
Adapting CBT to Help Millions in Low and Middle Income Countries
Richard Bryant, University of New South Wales, Australia
War, natural disaster, and humanitarian crises are a major global issue, disproportionately affecting people in low and middle income countries (LMICs). Most people in need of mental health interventions in LMICs do not receive appropriate care because of lack of resources, including having few mental health specialists. This review will outline a recent pattern of ‘task-shifting’, in which evidence-based strategies are delivered by lay providers who are trained to deliver mental health programs. This review will highlights recent initiatives by the World Health Organization to develop cognitive behavioral programs that are brief, transdiagnostic, and can be readily trained to lay providers with no mental health experience. These programs are underpinned by a focus on change mechanisms that have been chosen on the basis of evidence of treating common mental disorders. Randomized controlled trials will be described that have tested these interventions in adults and youth. Further, attempts to implement these programs into existing health services will be outlined, with the goal of demonstrating the importance of local capacity building to promote sustainability of evidence-based care in LMICs. Limitations of this approach will also be described and challenges this endeavor faces in the future will be explained, including the need to address more persistent and complex mental disorders that arise from trauma and adversity.
Professor Bryant is a Scientia Professor of Psychology at the University of New South Wales, and is Director of the Traumatic Stress Clinic. His work has focused on the nature, course, and treatment of traumatic stress and grief. He served on both the DSM-5 and ICD-11 diagnostic work groups. Professor Bryant has produced over 600 publications on traumatic stress and anxiety. He has developed with the World Health Organization transdiagnostic psychological interventions that can be delivered by lay providers in low and middle income countries. He has led multiple trials of psychological interventions in LMICs, and is currently involved in evaluating trials of transdiagnostic interventions for Syrian refugees in multiple countries in Europe and the Middle East.
Singla, D. R., Kohrt, B., Murray, L.K., Anand, A., Chorpita, B.F., & Patel, V. Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries. Annual Review of Clinical Psychology 13, 149-181,
Bryant, R.A., Schafer, A., Dawson, K.S., Anjuri, D., Mulili, C., Ndogoni, L., Koyiet, P., Sijbrandij, M., Ulate, J., Harper, M., Hadzi-Pavlovic, D., van Ommeren, M. (2017). Effectiveness of a Brief Behavioral Intervention on Psychological Distress among Women with a History of Gender-Based Violence in Urban Kenya: A Randomized Clinical Trial. PLOS Medicine, 14, e1002371.
Dawson, D., Bryant, R.A., Harper, M., Tay, A.K., Rahman, A., Schafer, A., & van Ommeren, M. (2015). Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry, 14, 354-357.
Realising the Mass Public Benefit of Evidence-Based Psychological Therapies
David Clark, University of Oxford, UK
Evidence-based psychological therapies have been developed for many mental health problems and surveys show that the public prefer psychological therapy to medication in a 3:1 ratio. However, in no country does the public get what it wants. Psychological therapies are only available to a small number of people and attempts to make them more widely available have been hampered by a shortage of suitably trained therapists and the high costs of traditional delivery models.
The English IAPT programme aims to get round these problems by training an extra 11,000 new psychological therapists and deploying them in specialist, stepped care psychological therapy services for anxiety disorders and depression which can be accessed by self-referral. From small beginnings in 2008, the programme has grown to a point where it treats over 560,000 per year. A session by session outcome monitoring system ensures that clinical outcome data is available on 99% of treated patients. In the interests of public transparency, the outcomes of all IAPT services are available on the worldwide web. Study of the variability of outcomes between services has helped to identify many organizational and other factors that are associated better outcomes. This information has been feedback to services and has helped 1) reduce variability and 2) achieve overall outcomes in a mass implementation that are broadly in line with those observed randomized controlled trials. Currently, around 7 in every 10 (68%) treated individuals show reliable and substantial reductions in their symptoms. In around 5 in every 10 (52%) the reductions are large enough for an individual to be classified as recovered. These outcomes have encouraged the UK government to commit to doubling the size of IAPT by 2024.
This talk explains how a combination of political lobbying, economic analyses and clinical data were used to gain an initial government commitment to start the IAPT programme. It then goes on to explain how the programme achieves its remarkably high data completeness rates, before discussing the many things the complete data has taught us about how to deliver psychological therapies at scale and economically. Despite its successes, IAPT is a work in progress. Limitations of the programme are discussed, along with likely future developments, including greater use of digitally assisted assessment, therapy, and follow-up. Development of IAPT-like services in several other countries is also discussed.
David M Clark is Professor of Experimental Psychology at the University of Oxford. He is well-known for his research on the understanding and treatment of anxiety disorders. With colleagues, he has developed new and effective forms of cognitive therapy for social anxiety disorder, panic disorder, and PTSD in adults and adolescents. Effective internet based versions of the social anxiety and PTSD treatments have also been developed. David is one of the original architects of the English Improving Access to Psychological Therapies (IAPT) initiative and is the National Clinical and Informatics Advisor for the programme.
Layard, R. and Clark, D.M. (2014). Thrive: The power of psychological therapy. Penguin, London
Clark, D.M. (2018). Realising the Mass Public Benefit of Evidence-Based Psychological Therapies: The IAPT Program. Annual Review of Clinical Psychology, 9, 1-25.
Clark, D.M., Canvin, L., Green, J, Layard, R.L., Pilling, S, and Janescka, M. (2018). Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Lancet, 391, 679-86
The Clinical Role of Wellbeing Therapy
Giovanni Fava, University of Bologna, Italy
A specific psychotherapeutic strategy for increasing psychological well-being and resilience, well-being therapy (WBT) has been developed and validated in a number of randomized controlled trials. The findings indicate that flourishing and resilience can be promoted by specific interventions leading to a positive evaluation of one’s self, a sense of continued growth and development, the belief that life is purposeful and meaningful, the possession of quality relations with others, the capacity to manage effectively one’s life, and a sense of self-determination. A decreased vulnerability to depression, mood swings, and anxiety has been demonstrated after WBT in high-risk populations. Its updated scope encompasses increasing resilience in a variety of psychiatric and medical conditions, modulating psychological well-being and mood, developing alternative pathways to established treatment modalities, including psychotropic drugs. An important characteristic of WBT is self-observation of psychological well-being associated with specific homework. Such perspective is different from interventions that are labelled as positive but are actually distress oriented. Another important feature of WBT is the assumption that imbalances in well-being and distress may vary from one illness to another and from patient to patient. The WBT manual has been translated in many languages and studies are in progress all over the world.
Giovanni A. Fava is currently Clinical Professor of Psychiatry at the State University of New York at Buffalo. He has authored more than 500 scientific papers and performed groundbreaking research in several fields. He has introduced a novel psychotherapeutic approach for increasing psychological well-being (Well-Being Therapy, www.well-being-therapy.com, which he has recently manualized) the sequential model for combining pharmacotherapy and psychotherapy, the concept of staging in psychiatry, a new method of classification of psychosomatic distress (the Diagnostic Criteria for Psychosomatic Research), the concept of oppositional tolerance with antidepressant treatment and the clinimetric approach to psychiatric evaluation. Since 1992, he is editor-in-chief of Psychotherapy and Psychosomatics, a journal published by Karger that, with its current impact factor of 13.12, ranks fourth among the SCI psychology journals (but it is the first of those publishing original research), and fifth in the psychiatry ranking. His current h index is in the sixties, with more than 12,000 citations.
Fava GA: Well-Being Therapy. treatment manual and clinical applications. Basel, Karger, 2016 (translations in German, French, Portuguese, Italian, Chinese, Japanese, and Hungarian)
Fava GA, Cosci F, Guidi J, Tomba E (2017). Well-being therapy in depression: New insights into the role of psychological well-being in the clinical process. Depression and Anxiety, 34, 801-808.
Taking Care of those who Care: Targets and Strategies in CBT for Distressed Dementia Family Caregivers
Andres Losada, King Juan Carlos University, Spain
The number of people suffering Alzheimer or related dementias is growing significantly worldwide. Through the long and changing journey of dementia, persons suffering the illness need supervision and care (even for 24 hours a day) for many demanding tasks. That care is usually provided by a family member. These facts help to understand why dementia family caregiving has been described as a prototypical example of chronic stress, and a natural experiment of extreme stress. Caregivers usually report high levels of depressive symptomatology and anxiety, as well as other emotions such as guilt or ambivalence. Physical health problems, such as elevated blood pressure, are also observed in this population. Research has shown the importance of several cultural, cognitive and behavioural factors in the explanation of caregivers’ distress. Drawing upon recent developments in theoretical and intervention studies in the caregiving field, including experimental and longitudinal studies, in this lecture I will introduce an integrated model explaining how several key variables, such as cultural values, dysfunctional thoughts, experiential avoidance, cognitive fusion, or emotional ambivalence and guilt, contribute to caregivers´ distress. Also, I will discuss how these dimensions can be targeted through interventions specifically designed to respond to each caregiver’s individual needs, as assessed through specific measures or procedures. I will describe some CBT and contextual techniques (strategies and exercises) that we have adapted or developed for addressing these targets in this population. These strategies will be described in the context of several research intervention projects that we have run in Spain, comparing cognitive behavioural therapy and acceptance and commitment therapy, testing the efficacy of a modular therapy guided by functional analysis, and, more recently, analyzing the efficacy of an individualized psychotherapeutic intervention for caregivers with high levels of distress and guilt feelings. The potential mechanisms of change of these interventions will be discussed, and recommendations for the improvement of the clinical significance of the interventions, and the maintenance of therapeutic benefits in the long-term in future research will be provided.
Andrés Losada is professor of clinical psychology and psychology of aging at the Universidad Rey Juan Carlos in Madrid, Spain. Director of the Research Group Cuid-Emos, recognized by the Global Ageing Research Network (GARN) and the International Association of Gerontology & Geriatrics. During the last 20 years he has been principal investigator in several research projects aimed at developing and analysing psychological therapies for dementia family caregivers. Together with his team and an extended international network, he has published several book chapters and articles in high impact journals on the efficacy of Cognitive Behavioural Therapies and Acceptance and Commitment Therapies, showing the effects of these interventions for reducing caregivers’ distress. He is also interested in the development and testing of assessment tools for dementia family caregivers, having developed specific measures for assessing experiential avoidance, ambivalence, dysfunctional thoughts or guilt feelings in this population. These measures have been translated and validated to several languages and are been used in clinical trials. Some of the works done by his team have received research awards.
Losada, A. (2018). Caregiving issues for older adults. Oxford Research Encyclopedia of Psychology. Doi: 10.1093/acrefore/9780190236557.013.436
Losada, A., Márquez-González, M., Romero-Moreno, R., Mausbach, B., López, J., Fernández-Fernández, V., & Nogales-González, C. (2015). Title: Cognitive Behavioral Therapy (CBT) versus Acceptance and Commitment Therapy (ACT) for dementia family caregivers: results of a randomized clinical trial. Journal of Consulting & Clinical Psychology, 83, 760-772
Márquez-González, M., Romero-Moreno, R., & Losada, A. (2010). Caregiving issues in a therapeutic context: New insights from the acceptance and commitment therapy approach. In N. Pachana, K. Laidlaw & Bob Knight (Eds.). Casebook of Clinical Geropsychology: International Perspectives on Practice (pp. 33-53). New York: Oxford. University Press.
Psychosis and Bipolar Disorder
Delusions and Other Strong Beliefs
Richard Bentall, University of Sheffield, UK
The problem of distinguishing between delusions and other incorrigible beliefs has taxed the greatest minds in psychopathology, and seems ever more important in an age of extreme ideology. Clinically, this problem leads to difficulties in deciding who should be the recipient of mental health care, especially in the forensic domain, in which professionals often fail to decide on whether a particular person (Ron and Dan Lafferty in the United States, Anders Breivik in Norway) is mentally ill. Standard criteria (e.g. that delusions are resistant to counter-argument and are “ununderstandable”) either do not stand up empirical scrutiny or collapse in the face of counter-examples (e.g. sudden religious conversion). A major element of the problem is that there is no agreed understanding of ‘belief’ against which delusions can be compared. This lacuna is remarkable, given that beliefs are thought to play a central role in all types of psychopathology (not just psychosis, but, for example, depression and anxiety disorders) and, indeed, all of the social sciences (not just psychology but sociology, anthropology, and history).
In this talk I will draw together evidence from a wide range of sources (including human learning theory and political psychology) to sketch out a two-process account of belief. I will describe a set of Master Explanatory Systems which include conspiracy theories, religious beliefs, supernatural beliefs and (arguably) political ideologies, which share common characteristics with delusional (especially paranoid) beliefs. Using recent survey evidence I will show that these beliefs exist along continua with less extreme beliefs, and that they are the consequence of the dominance of type-1 (associative, emotional) reasoning over type-2 (slow, analytic reasoning). Using data from psychiatric patients I will describe parallel findings for clinical paranoia. The only distinguishing feature of delusions seems to be that they are idiosyncratic, possibly reflecting social isolation and/or an inability to calibrate beliefs according to response from others.
I will conclude by discussing implications for clinical practice, public mental health and (briefly) current world events.
Richard Bentall is Professor of Clinical Psychology at SheffieldUniversity and has previously held chairs at Liverpool, Manchester and Bangor Universities. He graduated with a BSc and then a PhD in experimental psychology at the University College of North Wales (now Bangor University) and then completed his clinical training at Liverpool University. He also holds an MA in philosophy applied to health care awarded by University College Swansea (now Swansea University). His research interests have mainly focused on psychosis. He has studied the cognitive and emotional mechanisms involved in psychotic symptoms such as hallucinations, paranoid delusions and manic states, using methods ranging from psychological experiments, and experience sampling to functional magnetic resonance imaging. Most recently, his research has focused on why social risk factors (for example childhood adversities such as poverty, abuse, and bullying) provoke the cognitive and emotional changes that lead to these symptoms, leading to a new research focus on public mental health. In collaboration with colleagues at Manchester and elsewhere he has also conducted large scale randomized controlled trials of psychological interventions for people diagnosed with schizophrenia, bipolar disorder and prodromal psychosis, and is currently conducting a feasibility trial of EMDR for psychotic patients with a history of trauma. He has published over 250 peer-review papers and a number of books including Madness explained: Psychosis and human nature (Penguin, 2003) and Doctoring the mind: Why psychiatric treatments fail (Penguin, 2009). In 2014 he was elected a Fellow of the British Academy
Bentall, R.P. (2018) Delusions and other beliefs. In Bortolotti, L. [Ed.] Delusions in context (pp 67-89), Palgrave MacMillan (free to download at https://link.springer.com/book/10.1007%2F978-3-319-97202-2)
Bipolar Disorder in Youth: An Early Intervention Approach
David Miklowitz, University of Calafornia, USA
The speaker will review his work on the use of psychosocial interventions as adjuncts to pharmacotherapy in bipolar disorder. His most recent work is on the early stages of bipolar disorder in children and adolescents. He will review a targeted psychosocial intervention – family-focused therapy – to enhance the outcomes of young patients at high risk for bipolar disorder: those with early signs of depression or hypomania, psychosocial impairment, and a family history of bipolar disorder. A recent trial conducted in three sites indicates that children at high risk who receive 4 months of family-focused treatment have longer times to depressive recurrence and less severe manic symptoms than those who receive a comparison intervention consisting of 4 months of psychoeducation and support. With effective treatment and the support of their families, young patients with bipolar disorder can learn to manage their disorder and become independent and healthy adults.
Dr. Miklowitz is Professor of Psychiatry in the Division of Child and Adolescent Psychiatry at the UCLA Semel Institute, and a Senior Clinical Research Fellow in the Department of Psychiatry at Oxford University. His research focuses on family environmental factors and family interventions for children, adolescents and adults with bipolar disorder. His work has helped establish the effectiveness of psychosocial interventions as adjuncts to medication in the treatment of bipolar disorder.
Dr. Miklowitz has received numerous awards for his research and writings including Young Investigator Awards from the International Congress on Schizophrenia Research (1987) and the National Alliance for Research on Schizophrenia and Depression (NARSAD) (1987), a Distinguished Investigator Award from NARSAD (2001), the 2005 Mogens Schou Award for Research from the International Society for Bipolar Disorders, the 2009 Gerald L. Klerman Senior Research Investigator Award from the Depressive and Bipolar Support Alliance, and the 2011 Bipolar Mood Disorder Research Award from the Brain and Behavior Research Foundation. In 2017, he won the Distinguished Scientist Award from the Society for the Science of Clinical Psychology. He has received multiple grants for his research from the National Institute of Mental Health and private foundations. Dr. Miklowitz has published over 300 journal articles and chapters, and 8 books. His book Bipolar Disorder: A Family-Focused Treatment Approach (Guilford), won the 1998 Outstanding Research Publication Award from the American Association for Marital and Family Therapy. His book “The Bipolar Disorder Survival Guide” is an international bestseller that has been translated into 8 languages, with 275,000 copies in print. His most recent book, written with psychiatrist Michael Gitlin, M.D., is called “Clinician’s Guide to Bipolar Disorder.”
Miklowitz, D. J. (2010). Bipolar Disorder: A Family-Focused Treatment Approach (2nd Edition, revised). New York: Guilford Publications.
Miklowitz, D. J. & Chung, B. (2016). Family-focused treatment for bipolar disorder: reflections on 30 years of research. Family Process, Jul 29. doi: 10.1111/famp.12237. [Epub ahead of print].
Miklowitz, D. J., Schneck, C. D., Singh, M. K., Taylor, D. O., George, E. L., Cosgrove, V. E., Howe, M. E., Dickinson, L M., Garber, J., & Chang, K. D. (2013). Early intervention for symptomatic youth at risk for bipolar disorder: a randomized trial of family-focused therapy. Journal of the American Academy of Child and Adolescent Psychiatry, 52(2), 121-131.
Sex, Marital and Family Relationships
Couple-based Interventions for Adult Psychopathology: Broadening the CBT Paradigm while Remaining True to its Roots
Don Baucom, University of North Carolina, USA
Cognitive-behavioural therapy (CBT) principles have proven to be highly efficacious for treating a variety of psychological disorders in adults. Yet some individuals do not benefit; others relapse following treatment, and some drop out before treatment is completed. Therefore, it is important to build upon current treatment principles to address these issues and strengthen clinical interventions even further.
One potential way to increase treatment effectiveness is to recognize that “individual disorders” exist in a social context. In particular, an extensive body of research findings indicate that an individual’s committed, intimate relationship such as marriage
impacts and is impacted by psychological disorders. Consequently, including a partner in the treatment of adult psychopathology has the potential to harness the social context for treatment success while also addressing interpersonal factors that might interfere with optimal outcomes.
The current presentation highlights the empirical background detailing the concurrent and longitudinal associations between psychopathology and relationship functioning. A conceptual framework for the various ways in which both distressed and nondistressed relationships can contribute to the precipitation, maintenance, and exacerbation of psychopathology is presented. Similarly, the routes through which satisfying relationships can serve as a resource for alleviating psychopathology are discussed.
Based upon these empirical findings and conceptual framework, the rationale and format for couple-based treatments for psychopathology are described, with a focus on treating the disorder rather than emphasizing relationship adjustment as the primary goal of treatment. Three different types of couple-based interventions that can be applied to a variety of disorders are differentiated. These interventions, which are employed with both partners together, include the integration of treatment principles from individual CBT along with couple intervention strategies from cognitive-behavioural couple therapy.
The presentation concludes with results of several intervention trials employing couple-based interventions, including the treatment of obsessive-compulsive disorder, anorexia nervosa, binge eating disorder, and depression. Although some of these couple-based interventions for psychopathology are still in the early stages of evaluation, initial findings are encouraging when compared to individual CBT treatments. Clinical guidelines and recommendations regarding when to employ these interventions, the partial inclusion of partners in treatment, and additional treatment developments for the future are discussed.
Overall, implications for the future of CBT given these developments are briefly discussed, with considerations for a proposed paradigm shift in systematically considering the interpersonal context of psychopathology in treatment.
Donald H. Baucom is Richard Simpson Distinguished Professor of Psychology at The University of North Carolina at Chapel Hill, USA. Since he received his doctorate in clinical psychology in 1976, he has been actively involved in developing and evaluating couple-based interventions from a cognitive-behavioural perspective. This work has included focusing on interventions for relationally distressed couples, employing couple-based interventions for couples in which one partner has a psychological or medical problem, treating infidelity, and preparing couples for marriage or committed relationships. He has been a pioneer in developing and evaluating couple-based interventions for depression, anxiety, and eating disorders, the focus of the current presentation. In addition to his research in the couple’s area, he and Norman Epstein have published two widely used books on cognitive-behavioural couple therapy. He also has been an active clinician in private practice with couples for 43 years. He has won several teaching awards, and he holds an Endowed Chair at the University of North Carolina for his research contributions to the field. He also has received awards for his excellence in clinical supervision and mentoring doctoral students. He gives frequent talks and workshops to professionals around the world with a particular commitment to making empirically supported interventions applicable in real world, clinical settings.
Baucom, D.H., Fischer, M.S., Worrell, M., Corrie, S., Belus, J.M., Molyva, E., & Boeding, S.E. (2018). Couple-based intervention for depression: An effectiveness study in the National Health Service in England. Family Process, 57 (2), 275-292. doi: 10.1111/famp.12332
Baucom, D H., Kirby, J.S., Fischer, M.S., Baucom, B.R., Hamer, R., & Bulik, C.M. (2017). Findings from a couple-based open trial for adult anorexia nervosa. Journal of Family Psychology,31(5), 584-591. doi: 10.1037/fam0000273
Fischer, M.S. & Baucom, D.H. (2018). Couple-based interventions for relationship distress and psychopathology. In J. N. Butcher & J. Hooley (Eds.), APA Handbook of Psychopathology (Vol. 1, pp. 661-686). Washington, DC: American Psychological Association.
The State of the Art of Cognitive and Behavioural Therapy for Sexual Problems: New Developments from Basic Science and Clinical Implications
Pedro Nobre, University of Porto, Portugal
Sexual Dysfunctions are highly prevalent in men and women across the world and constitute a major health problem (Laumann et al.,1999).
In the last three decades, several clinical and laboratorial studies have been emphasizing the role played by psychological variables on sexual response and functioning. Sexual beliefs (Heiman & LoPiccolo, 1988; Zilbergeld, 1999), efficacy expectations (Bach et al., 1999), cognitive distraction and attentional focus (Dove & Wiederman, 2000; Elliot & O’Donohue, 1997), attributional style (Weisberg et al., 2001), affect (Mitchell et al., 1998; Nobre et al., 2003), and physiological variables (Barlow, et al., 1983; Meston & Gorzalka, 1996) are among the most studied variables.
Despite the accumulated knowledge about the role of psychological factors in the etiology and maintenance of sexual dysfunctions (SD), there is a lack of evidence based models of SD, and a dearth of randomized control trial studies (RCT) testing the efficacy of psychological interventions. With the exception of Barlow’s model (1086), little effort has been made to develop evidence-based comprehensive models that explain the factors involved in predisposing and maintaining sexual dysfunction in men and women.
In order to cover that gap, Nobre and colleagues have conducted a series of studies on the influence of cognitive schemas (Nobre & Pinto-Gouveia, 2010), sexual beliefs (Nobre et al., 2003, 2006a), automatic thoughts (Nobre & Pinto-Gouveia, 2003, 2008), and emotions (Nobre & Pinto-Gouveia, 2003, 2006b) on sexual dysfunction. Results showed the strong influence of cognitive and emotional variables on sexual response and allowed the development of explaining models for sexual dysfunction in men and women (Nobre, 2010a, 2010b).
These conceptual models are currently being tested in our SexLab (www.fpce.up.pt/sexlab/) using experimental and longitudinal designs. Moreover, fMRI studies and a treatment outcome study is also undergoing to test the efficacy of Cognitive behaviour therapy (CBT) for erectile dysfunction when compared to medication. Studies on predictors of subjective and physiological response to erotic material in the laboratory have shown that cognitions and emotions (e.g., sexual thoughts and positive emotions) are significant predictors of subjective arousal, whereas physiological arousal in both men and women seems to be relatively independent from these psychological dimensions (Oliveira et al., 2014; Vilarinho et al., 2014). These findings suggest that psychotherapy (e.g., CBT) may have a significant impact on enhancing levels of subjective sexual arousal in men and women regardless of the genital response.
Additionally, preliminary findings of the RCT suggest that CBT may be superior to medication in maintaining treatment gains in men with Erectile Dysfunction at 3 and 6 month follow-up. Results are in line with previous studies indicating that CBT yield more durable benefits than different pharmacological interventions for different psychological problems (e.g., depression, anxiety disorders).
Pedro Nobre is currently President of the World Association for Sexual Health (2017-2021) and Professor of Psychology at Porto University. He is also Director of the Doctoral Program in Human Sexuality and Coordinator of the Laboratory for Research in Human Sexuality (SexLab) at Porto University as well as Research Fellow at the Kinsey Institute (USA). He is also responsible for various research projects on sexual health, has published over 100 scientific papers in international journals and is a member of the editorial board of the Journal of Sexual Medicine, Archives of Sexual Behavior, Journal of Sex Research, and International Journal of Clinical & Health Psychology. Moreover, he received several international prizes for scientific merit including the Best Paper Award presented at the WAS world meeting in 2007 (Runner-up). Pedro Nobre is Past-President of the Portuguese Society of Clinical Sexology (2008-2011) and was President of the Organizing Committee of the 10th Congress of the European Federation of Sexology (2010) and Co-chair of the IASR meeting in 2012. He was Chair of the Scientific Committee of the World Association for Sexual Health (2013 – 2017) and member of the WAS Advisory Committee where he is the project leader of the World Database on Sexual Health.
Nobre, P. J. (2010). Psychological Determinants of Erectile Dysfunction: Testing a Cognitive-Emotional Model. Journal of Sexual Medicine, 7, 1429-1437.
Nobre, P. J., & Pinto-Gouveia, J. (2008). Differences in automatic thoughts presented during sexual activity between sexually functional and dysfunctional males and females. Journal of Cognitive Therapy and Research, 32, 37-49.
Nobre, P. J., Pinto-Gouveia, J. (2006). Dysfunctional Sexual Beliefs as Vulnerability Factors to Sexual Dysfunction. Journal of Sex Research, 43, 68-75.
Therapeutic and Applied Issues
Schema Therapy: Latest Research Findings and Clinical Applications
Arnoud Arntz, University of Amsterdam, The Netherlands
In this invited address I will focus on new developments and research findings in Schema Therapy (ST) for personality disorders.
ST has become quite popular as a treatment for personality disorders and other chronic conditions, and the good effectiveness, low dropout, and high attractiveness of the model for patients and therapists might all have contributed to that. However, the basic theory underlying ST, and especially the schema mode model that is currently dominant, is not always well understood. In the first part of this contribution I will therefore first discuss the links between emotional needs, schemas, coping with schema activation, and schema modes. Based on the theory of Dweck on emotional needs, I will argue that a specific area has so far been overlooked in ST theory. I will present an extension of the theoretical model and discuss the (important) clinical implications.
In the second part of this contribution I will focus on recent empirical findings on the effectiveness of ST. A recent development in Schema Therapy (ST) is the shift from individual treatment to group treatment. By using the group dynamics in a specific way, the idea is that schema change processes are catalysed. However, it is unclear what the preferred format should be: pure (or mainly) group therapy, or the combination of individual and group ST. A large international RCT (N > 480 patients) tested these two formats of group ST as treatment for Borderline Personality Disorder, and compared them to optimal treatment as usual. The very first results will be presented. More specifically, the following issues will be addressed: what was the most effective format? Which format had the lowest dropout? How to these results compare to individual ST for Borderline Personality Disorder? And, how did participants experience the treatment?
Arnoud Arntz is professor of Clinical Psychology at the University of Amsterdam, the Netherlands, with an affiliation at Maastricht University, the Netherlands. His main research interests lie in the fields of personality disorders and PTSD, both applied and fundamental. He also practices as a therapist at PsyQ in Amsterdam, where he treats patients with trauma and personality disorders. He is a former co-editor of the Journal of Behavior Therapy and Experimental Psychiatry.
His research focuses on psychological processes underlying personality disorders (PDs), especially borderline personality disorder (BPD), and PTSD; and their treatment. Using the approach of experimental psychopathology he tested psychological theories of anxiety disorders and PDs and contributed to the development of their psychological treatment. In developing and testing psychological theories and treatments he aims to connect basic research and clinical work. He is perhaps best known for his contributions to the development of Schema Therapy and Imagery Rescripting. He was project leader of the multicenter RCT that compared schema therapy (ST) to Transference Focused Psychotherapy as treatments of Borderline PD, and of another multicenter RCT that compared ST to treatment as usual (TAU) and CCT for 6 other PDs. Currently he is PI of an international RCT comparing working mechanisms of Imagery Rescripting and EMDR for PTSD that originated from childhood traumas, and together with Dr Joan Farrell PI of the international RCT that compares group-ST to TAU for Borderline PD. Professor Arntz also chairs a Dutch-German collaborative study investigating basic brain and cognitive processes in BPD and their change during treatment, which is associated with the international RCT on group-ST.
Arntz, A., & Genderen van, H. (2009). Schema Therapy for Borderline Personality Disorder. Chichester: Wiley.
Dweck, C. S. (2017). From needs to goals and representations: Foundations for a unified theory of motivation, personality, and development. Psychological Review, 124(6), 689–719.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.
The Therapeutic Relationship in Cognitive Behaviour Therapy
Judith Beck, Beck Institute for Cognitive Behavioural Therapy, USA
Some clients (and therapists) bring distorted beliefs about themselves and other people to the therapy session. As a result of their genetic inheritance, their formative experiences, and the appraisal of their experiences, they develop certain “rules for living” and associated behavioral strategies, which may be adaptive in certain situations but are maladaptive in other contexts. Their dysfunctional beliefs may become activated in the context of psychotherapy and they may employ certain coping strategies which interfere with the development of a strong therapeutic alliance and with clients’ ability to benefit from treatment. Conceptualizing relevant therapy-interfering beliefs about the therapist and associated maladaptive coping strategies is fundamental to planning interventions that can not only strengthen the alliance but that also can be generalized to improve their relationships outside of therapy.
Judith S. Beck, Ph.D., is President of Beck Institute for Cognitive Behavior Therapy, a non-profit organization in Philadelphia, Pennsylvania, USA. The Beck Institute offers national and international training in CBT, certification of clinicians and accreditation of organizations. Dr. Beck is also clinical professor of psychology at the University of Pennsylvania. She divides her time among administration, supervision and teaching, clinical work, program development, research, and writing. She has presented hundreds of workshops nationally and internationally on various applications of cognitive therapy. Dr. Beck has written over 100 articles and chapters. She is the author of the primary text in the field, Cognitive Behavior Therapy: Basics and Beyond, which has been translated into 20 languages. Her other books include Cognitive Therapy for Challenging Problems, Cognitive Therapy for Personality Disorders, the Oxford Textbook of Psychotherapy, and the Beck Diet Solution. The online CBT courses she has developed have been taken by people in 112 countries.
Safran, J. D., & Kraus, J. (2014). Alliance ruptures, impasses, and enactments: A relational perspective. Psychotherapy, 51(3), 381.
Safran, J. D., Muran, J. C., & Eubanks-Carter, C. (2011). Repairing alliance ruptures. Psychotherapy, 48(1), 80.
Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98.
Personal Practice: Why Therapists Should Walk the Talk
James Bennett-Levy, University of Sydney, Australia
Should therapists have personal therapy, and/or engage in other forms of personal practice? Are there benefits? What (if any) is the impact on therapist skills? Or client outcomes? Should personal practice play a part in therapist training and professional development?
Since the time of Freud, debate has raged about the value of personal practice. During the 20th century, personal practice usually meant personal therapy. Whether or not a therapist engaged in personal therapy was largely a matter of preference, belief, and choice – and which school of psychotherapy you were trained in. There was little empirical evidence for its value.
However since the turn of the century, a new landscape of personal practices has emerged, together with a new wave of research. Foremost amongst these personal practices have been self-practice/self-reflection (SP/SR) programs and meditation programs for therapists. Bringing together empirical research on SP/SR programs, meditation programs and personal therapy, we can now ask a broader set of questions about personal practice such as: Are different kinds of personal practice of value for therapists – or not? Do they have a role in enhancing therapist effectiveness and client outcomes? If so, how might they be of value? With a growing evidence base and a recent theoretical model (Bennett-Levy & Finlay-Jones, 2018; Bennett-Levy, 2019), we are starting to understand rather better how learning “from the inside out” may impact on therapist skills – and in particular on the personal and interpersonal qualities of therapists.
In this keynote, James Bennett-Levy will suggest that the time has come for therapists to “walk the talk” – for personal practice to play a core role in therapist training and professional development. Bringing together research on the qualities of effective therapists, and comparing outcomes from conventional training strategies with outcomes from personal practice, James will suggest that different types of personal practice can develop key aspects of therapist skill development which are beyond the scope of conventional skills training. He will further suggest that the personal and interpersonal qualities developed through personal practice are central to effective client outcomes.
He will conclude that, alongside a paradigmatic shift towards more process-based therapies, it is timely for educators, therapists and researchers to include personal practices in their training and professional development, and to evaluate the impact. In particular it will be helpful to ask: which forms of personal practice are most effective for which outcomes, with which practitioners, in what contexts, at what point in time?
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 making important theoretical and empirical contributions. Over the past 20 years, his pioneering self-experiential approach to therapist training, known as self-practice/self-reflection (SP/SR), has become increasingly influential internationally, sprouting empirical research in different countries, and leading to the Guilford Press’ Series, Self-Practice/Self-Reflection (SP/SR) Guides for Psychotherapists, for which James is Series Editor. He has co-authored two of these books in this series, Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists (Bennett-Levy, Thwaites, Haarhoff & Perry, 2015) and Experiencing Compassion focused therapy from the Inside Out; : A Self-Practice/Self-Reflection Workbook for Therapists (Kolts, Bell, Bennett-Levy & Irons, 2018).
Recognising the need to create better theoretical frameworks to guide training research and education, James developed the Declarative-Procedural-Reflective model (Bennett-Levy, 2006; Bennett-Levy & Thwaites, 2007) and the Personal Practice model (Bennett-Levy & Finlay-Jones, 2018). In the Australian context, he has led projects to train Aboriginal health professionals in digital mental health strategies (Bennett-Levy et al., 2017), compassion-based approaches, and CBT (Bennett-Levy et al., 2014, 2015); and to develop online therapist training (Bennett-Levy et al., 2009, 2012).
With an eye to creating books on topics he most wants to learn about, James has previously co-authored/co-edited three influential books for therapists, the Oxford Guide to Behavioural Experiments in Cognitive Therapy (Bennett-Levy, Butler, Fennell, Hackmann, Mueller & Westbrook, 2004), the Oxford Guide to Low Intensity Interventions (Bennett-Levy et al., 2010) and the Oxford Guide to Imagery in Cognitive Therapy (Hackmann, Bennett-Levy & Holmes, 2011).
James has taught in 24 countries. The World Congress in Berlin will be his 25th. Over the next years, he looks forward to teaching further afield, in particular developing CBT countries.
Bennett-Levy, J. (2019). Why therapists should walk the talk: The theoretical and empirical case for personal practice in therapist training and professional development. Journal of Behavior Therapy and Experimental Psychiatry, 62, 133-145.
Bennett-Levy, J., & Finlay-Jones, A. (2018). The role of personal practice in therapist skill development: A model to guide therapists, educators, supervisors and researchers. Cognitive Behaviour Therapy, 47, 185-205.
Castonguay, L. G., & Hill, C. E. (2017). How and why are some therapists better than others? Understanding therapist effects. Washington, D.C.: American Psychological Association.
Identifying Psychotherapy Processes and Mechanisms Using the Tools of Precision Medicine
Rob DeRubeis, University of Pennsylvainia, USA
Over the past decade the research literature on precision mental health has evolved from rare and obscure to prominent and promising. The primary aim of research in this area is to develop tools that will increase the effectiveness and efficiency of treatments for mental health problems. Although the algorithms that demonstrate predictive utility are treated as “black boxes,” a look inside the boxes can stimulate focused efforts to identify the processes and mechanisms that account for treatment success or failure for each individual who engages in an evidence-based treatment.
The speaker will first illustrate a scheme that depicts two sources of heterogeneity that any powerful explanatory system will need to account for: (a) differences along a dimension of prognosis, from those very likely to improve with little if any treatment to those unlikely to improve even with the most powerful treatment; and (b) differences in regard to which treatments – and elements within a treatment – are those that will maximize a given patient’s likelihood of experiencing sustained improvement. Several empirical investigations – some published, some in earlier stages – will be used to exemplify this approach to the study of processes and mechanisms.
In a randomized trial of treatments for Panic Disorder, baseline characteristics that predicted differential benefit from CBT and a panic-focused psychodynamic therapy pointed to the possibility that different mechanisms of change were at work in the two treatments. Using this information, we found that patients entering treatment with a greater tendency toward catastrophic interpretations of bodily symptoms experienced greater benefit from improvement in catastrophic interpretations, whereas patients with a lesser tendency to catastrophize did not experience more symptom improvement when they experienced these changes.
In a relapse prevention trial comparing antidepressant continuation vs. ADM discontinuation+MBCT in patients who remitted while on medication treatment, we found several baseline variables that, collectively, contributed to the prediction of which preventative approach would be optimal for any given patient. Changes in those variables observed from baseline to 12 weeks (post-treatment) were associated with resistance to relapse across the 2-year follow-up period, and they largely accounted for the predicted differential benefit from the treatments.
Other examples of this approach will be described that have been used to identify which patients are most likely to benefit more from a stronger vs. a weaker treatment, and which patients are most likely to benefit from a high positive therapeutic alliance.
Rob DeRubeis has been a member of the Psychology faculty at the University of Pennsylvania since he received his PhD in Clinical Psychology from the University of Minnesota 1983. During his time at Penn he has served as Associate Dean, Department Chair, and Director of Penn’s Doctoral Training Program Clinical Psychology. He has published well over 100 papers, the majority of which center on the treatment of depression, and he has received career awards for his research from, among others, the Society for Psychotherapy Research and the Association for Psychological Science. Along with his students, he has developed assessment tools that continue to be used in psychotherapy research, including measures of therapist adherence and patient’s absorption of cognitive therapy skills, and he has introduced to the field a variety of clinical research methods, including mega-analysis and investigations of “sudden gains.” His empirical research comparing the benefits of cognitive therapy and medications for severe depression, published in the American Journal of Psychiatry and the Archives of General Psychiatry, has been the subject of media reports in The Economist, the Wall Street Journal, and USA Today. He has spoken about his work on podcasts and radio and television news programs, as well as to the Congressional Biomedical Research Caucus in Washington, DC.
Early in this decade, Dr. DeRubeis and his team embarked on a mission to test the limits of actuarial methods in support of precision mental health. These efforts led to the development of the Personalized Advantage Index and to their hosting, at Penn in 2016, the first Treatment Selection Idea Lab (TSIL). The second TSIL, held at University College London in 2018, focused on the results of a precision mental health data tournament. Thirteen teams from around the world competed to produce the most useful multivariable model, the aim of which was to predict the patients who were most and least likely to recover after receiving the lower intensity treatment in the UK’s IAPT system. He is now exploring the ability of these models to sharpen research on the processes and mechanisms of psychological treatments for mental health problems.
Rob and his wife of 37 years are proud parents of two daughters who this year will begin careers in mental health after completing advanced degrees in Clinical Psychology and Social Work, respectively. In the past decade especially, Dr. DeRubeis has enjoyed the privilege of traveling to and residing in Europe to pursue research collaborations with colleagues in Holland, the U.K., Germany, and Spain. He has also hosted, at Penn, more than a dozen visiting clinical scholars from across Europe, and he looks forward to future opportunities to interact with clinical scientists from around the world.
Cohen, Z. D., & DeRubeis, R. J. (2018). Treatment selection in depression. Annual Review of Clinical Psychology, 14, 209-236.
Forand, N. R., Huibers, M. J., & DeRubeis, R. J. (2017). Prognosis moderates the engagement–outcome relationship in unguided cCBT for depression: A proof of concept for the prognosis moderation hypothesis. Journal of Consulting and Clinical Psychology, 85, 471-483.
Lorenzo-Luaces, L., DeRubeis, R. J., Van Straten, A., & Tiemens, B. (2017). A prognostic index (PI) as a moderator of outcomes in the treatment of depression: A proof of concept combining multiple variables to inform risk-stratified stepped care models. Journal of Affective Disorders, 213, 78-85.
Evolution, Attachment and Compassion Focused Therapy
Paul Gilbert, University of Derby, UK
Cognitive behaviour therapists have always recognised that many of our dispositions for certain kind of goals and motives (to avoid harm, to connect with others, develop attachment relations with the young and partners) along with our emotions and ways of thinking, are rooted in evolved mechanisms (Beck 1983; Beck et al., 1985, Marks 1987). This talk will outline how the evolution of attachment and other prosocial motives and behaviours created brain processes that are central to the regulation of emotion, and prosocial versus antisocial behaviour. In addition, it will outline how compassion focused therapy evolved out of CBT and has now been integrated into CBT. Attention will also be given to some of the central practices of compassion focused therapy which are designed to stimulate these internal physiological systems and create a compassionate mind. Developing a compassionate mind and that self-identity then becomes a central therapeutic aim which is used to address kind difficulty such as self-criticism shame and trauma.
Beck, A.T. (1987). Cognitive models of depression. Journal of Cognitive Psychotherapy: An International Quarterly, 1, 5‑38
Beck, A.T., Emery, G. and Greenberg, R.L. (1985) Anxiety Disorders and Phobias: A Cognitive Approach. New York: Basic Books.
Marks, I.M. (1987). Fears, Phobias, and Rituals: Panic, Anxiety and their Disorders. Oxford: Oxford University Press.
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 21 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 (www.compassionatemind.co.uk). There are now a number of sister foundations in other countries. He was awarded an OBE by the Queen in March 2011 for services to mental health. He established and is the Director of the Centre for Compassion Research and Training at Derby University UK. He has written and edited many books on compassion. His latest Book is Living Like Crazy.
Gilbert, P. (2000). Social Mentalities: Internal ‘Social’ Conflicts and The Role of Inner Warmth and Compassion in Cognitive Therapy. In, P. Gilbert and Bailey K.G (eds.) Genes on the Couch: Explorations in Evolutionary Psychotherapy (p.118-150). Hove: Psychology Press.
Gilbert, P. (2010). Compassion Focused Therapy: The CBT Distinctive Features Series. London: Routledge.
Gilbert, P. (2017, ed)). Compassion: Concepts, Research and Applications. London: Routledge.
Developing Transdiagnostic CBT Treatments for Better Practice
Allison Harvey, University of California, Berkeley, USA
Psychological disorders remain common, chronic and difficult to treat. Progress toward developing effective interventions must include the identification of novel intervention targets that are safe, powerful, inexpensive and deployable. This talk will describe two novel intervention targets and address approaches proposed to hasten progress including (1) the use of science to derive and disseminate treatments and (2) targeting treatment at a transdiagnostic process.
The first intervention target that will be described is sleep and circadian dysfunction. Persistent sleep and circadian dysfunction is associated with functional impairment, mood regulation and problem solving difficulties, increased work absenteeism, higher health-care costs and heightened risk of developing future comorbid health and psychiatric conditions. Sleep and circadian problems are important transdiagnostic targets as (1) various types of sleep and circadian dysfunction coexist with, predate and predict psychological disorders, (2) sleep and circadian dysfunction contributes to vicious cycles in psychological disorders and (3) it is clear that sleep and circadian dysfunction is modifiable. An observation that underpins our approach is that prior research has tended to treat specific sleep problems (e.g., insomnia) in specific diagnostic groups (e.g., depression). Yet real life sleep and circadian problems are often not so neatly categorized, particularly in psychological disorders where features of insomnia often overlap with delayed sleep phase, irregular sleep-wake schedules, and even hypersomnia. In the hope of addressing this complexity, the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C), was developed. Evidence from two recently completed RCTs involving high-risk youth and adults diagnosed with severe mental illness will be described. The latter was conducted in community mental health settings, which are publicly funded, under resourced and provide treatment to poor and underserved community members.
The second intervention target that will be described is patient memory for the contents of treatment. This target is important as poor memory for treatment is associated with worse treatment outcome. Data will be presented on the development and outcome from an approach to improving memory for treatment; namely, the adjunctive Memory Support Intervention. The Memory Support Intervention was distilled from the basic, non-patient research in cognitive science and education and is comprised of eight powerful memory promoting strategies that are proactively, strategically, and intensively integrated into treatment-as-usual.
Allison G. Harvey, PhD, is a Professor, Clinical Psychologist and Director of The Golden Bear Sleep and Mood Research Clinic in the Department of Psychology, University of California, Berkeley. Her clinical training and Ph.D. were completed in Sydney, Australia. Dr. Harvey moved to the University of Oxford as a postdoctoral fellow in the Department of Psychiatry and then joined the Department of Experimental Psychology as faculty with a Fellowship at St. Anne’s College. In 2004 she moved to UC Berkeley. Dr. Harvey has practiced as a cognitive-behavior therapist for more than 20 years. She is a treatment development researcher who conducts experimental and intervention studies focused on understanding and treating sleep and circadian problems, severe mental illness and treatment processes. She has published over 250 peer reviewed papers and chapters and has published 3 authored books. Her research programme is funded by the National Institute of Mental Health and National Institute of Child Health and Human Development. Dr. Harvey is a recipient of numerous awards including from the American Association for Behavior Therapy and from NARSAD. Dr. Harvey has also been awarded an Honorary Doctorate from the University of Orebro, Sweden and is a Fellow of the Association for Psychological Science.
Harvey, A. G., Lee, J., Smith, R., Gumport, N., Hollon, S. D., Rabe-Hesketh, S., Hein, K., Dolsen., M.R., Hamen, K., Kanady, J., Thompson, M. A. & Abrons, D. (2016). Improving outcome for mental disorders by enhancing memory for treatment. Behavior Research and Therapy, 81, 35-46.
Harvey, A.G., Hein, K., Dolsen, M.R., Dong, L., Rabe-Hesketh, S., Gumport, N.B., Kanady, J., Wyatt, J.K., Hinshaw, S.P., Silk, J.S., Smith, R.L., Thompson, M.A., Zannone, N., & Blum, D.J. (in press). Modifying the impact of eveningness chronotype in adolescence: a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry.
Harvey, A.G., & Buysse, D. J. (2017). Treating Sleep Problems: A Transdiagnostic Approach. New York: Guilford Press.
Steven Hayes, University of Nevada, USA
As the “protocols for syndromes” era of evidence-based therapy passes away, a process-based alternative is rising in its place. As it does so, a number of practical and scientific challenges are coming to the fore in the behavioral and cognitive therapies. Fundamental changes are needed in research, research strategy, training, assessment, diagnosis and application in order to take full advantage the opportunities for advancement provide by process-based CBT.
In this talk I will enumerate several of these challenges and show how profound their implications are for our field, and its role in the behavioral and life sciences more generally. Among the challenges I will address are:
- a weak knowledge base in the area of processes of change;
- a cacophony of so-called transdiagnostic processes and models;
- inadequacies in basic knowledge and poor guidance by the helping professions in redressing them;
- the methodological inadequacy of mediation as a means of identifying processes of change;
- assessment quality standards based on the wrong questions and wrong level of analysis;
- the toxic long term social and scientific effects of the latent disease model that our dalliance with the DSM produced;
- poor assessment of contextual variables;
- protocol focused training and certification approaches to competence;
- and weak linkages to the life sciences generally.
As I will attempt to show, all of these problems are solvable, but not without modifications of current practices. The behavioral and cognitive therapies have an exciting future ahead if we are able to rise to the challenges our process-based future presents.
Steven C. Hayes is Nevada Foundation Professor in the Behavior Analysis program at the Department of Psychology at the University of Nevada. An author of 44 books and nearly 625 scientific articles, his career has focused on an analysis of the nature of human language and cognition and the application of this to the understanding and alleviation of human suffering. He is the developer of Relational Frame Theory, an empirical behavioral account of human higher cognition, and has guided its extension to Acceptance and Commitment Therapy (ACT), a popular evidence-based form of behavioral and cognitive therapy that uses mindfulness, acceptance, and values-based methods to foster psychological flexibility. In concert with Stefan Hofmann and other colleagues he has more recently been attempting to help transition evidence-based intervention from a “protocols for syndromes” to a process-based approach. Dr. Hayes has been President of several scientific and professional associations including the Association for Behavioral and Cognitive Therapies, and the Association for Contextual Behavioral Science. His work has been recognized by several awards including the Exemplary Contributions to Basic Behavioral Research and Its Applications from Division 25 of APA, the Impact of Science on Application award from the Society for the Advancement of Behavior Analysis, and the Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapy.
Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (in press). The role of the individual in the coming era of process-based therapy. Behaviour Research and Therapy. Doi: 10.1016/j.brat.2018.10.005
Hayes, S. C. & Hofmann, S. G. (2018). (Eds.), Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. Oakland, CA: Context Press / New Harbinger Publications.
Hofmann, S. G. & Hayes, S. C. (2019). The future of intervention science: Process based therapy. Clinical Psychological Science, 7(1), 37–50. Doi: 10.1177/2167702618772296
YOU are not supposed to feel that way: Making Room for Difficult Emotions
Robert Leahy, American Institute for Cognitive Therapy, USA
Much of CBT has focused on helping individuals get rid of unpleasant emotions—especially anxiety, sadness, and anger. But a life worth living often involves experiencing unpleasant emotions that are often complex emotions. Emotional Schema Therapy emphasizes that all emotions evolved because they were adaptive—including emotions that we are often told we should not have. These include jealousy, envy, ambivalence, boredom and regret. In addition, many of us struggle with Emotional Perfectionism and Existential Perfectionism—that is, the belief that we should feel good and that our lives should follow certain expectations that we have. But real life is filled with disappointments, loss, unfairness, and even betrayal. Just as people with OCD struggle with unwanted intrusive thoughts or people who ruminate look for “The Answer”, we often struggle to rid ourselves of unwanted feelings. In this presentation I describe a model of emotional inclusiveness, containment of unpleasant emotions, normalization of “the abnormal”, and the use of these emotions to differentiate the values and meanings that we have. I describe both the biological and the social constructivist models of emotions, recognizing that at different times in history and in different cultures people had different theories and evaluations of emotions. Of particular focus in this presentation is the role of jealousy, envy and ambivalence, problematic emotion theories and responses and possibly helpful strategies about how to cope with these inevitable and sometimes difficult experiences. Finally, I describe strategies for deepening meaning without avoiding the unpleasant emotions often associated with finding meaning.
Robert L. Leahy, PhD, is Director of the American Institute for Cognitive Therapy in New York and Clinical Professor of Psychology in the Department of Psychiatry at Weill Cornell Medical College. His research focuses on individual differences in emotion regulation and decision making. He is Associate Editor of the International Journal of Cognitive Therapy and is past president of the Association for Behavioral and Cognitive Therapies, the International Association for Cognitive Psychotherapy, and the Academy of Cognitive Therapy. He is a recipient of the Aaron T. Beck Award from the Academy of Cognitive Therapy. He is the author or editor of 27 books, including Cognitive Therapy Techniques, Second Edition; Treatment Plans and Interventions for Depression and Anxiety Disorders, Second Edition; Emotion Regulation in Psychotherapy, The Worry Cure, Anxiety-Free: Unravel Your Fears before They Unravel You, Beat the Blues Before They Beat You: How to Overcome Depression, Emotional Schema Therapy, The Jealousy Cure, Science and Practice in Cognitive Therapy: Foundations, Mechanisms, and Applications, Emotional Schema Therapy: Distinctive Features and many other books.
Leahy, R.L. (2015) Emotional Schema Therapy: A Practitioner’s Guide. New York: Guilford.
Leahy, R.L., Tirch, D., and Napolitano, L. (2011). Emotion Regulation in Psychotherapy: A Practitioner’s Guide. New York: Guilford.
Leahy, R.L. (2018) Emotional Schema Therapy: Distinctive Features. London: Routledge.
Action, Dialogue & Discovery: Reflections on Socratic Questioning 25 Year Later
Christine Padesky, Center for Cognitive Therapy, USA
Socratic questioning, now called Socratic dialogue, is no longer a chair-bound, predominantly cognitive intervention. Instead, it is most effective when paired with action-packed therapy methods such as behavioural experiments, role plays, imagery, and interactive writing. Pairing these action methods with Socratic dialogue increases engagement, elicits here and now data, and ensures discoveries are more memorable. One of the most frequently downloaded papers from our website is my first keynote address, delivered at the London EABCT conference in 1993 and titled, “Socratic questioning: Changing minds or guiding discovery?” It described and illustrated four stages of Socratic questioning and argued that the purpose of Socratic methods in CBT should be to guide discovery, not change minds. Today’s keynote summarizes the evolution of my thinking about Socratic methods over the past 25 years. The original 4-stage model of Socratic questioning is intact but we now emphasize its collaborative and interactive nature by calling it Socratic dialogue. Discovery is still the ultimate goal but the nature of these discoveries has expanded over the decades. In addition to examining existing beliefs, we now employ Socratic dialogue in the context of action therapy methods to identify strengths, guide development of new beliefs and behaviours, and inject greater potential for discovery into practical self-help exercises.
Christine A. Padesky, PhD, Co-Founder of Center for Cognitive Therapy in Huntington Beach, California is a Distinguished Founding Fellow of the Academy of Cognitive Therapy and a leading CBT innovator. Along with Kathleen Mooney, PhD, she created Strengths-Based CBT which helps clients construct new beliefs and behavioural strategies in order to improve overall functioning and relationships. Included in this approach is a 4-step protocol which helps people build a personal model of resilience.
Padesky has taught more than 500 workshops on 5 continents, provides consultation for therapists, hospitals and mental health clinics worldwide (www.padesky.com) and develops audio & video therapist training materials (www.store.padesky.com). Her presentations integrate theory, empiricism, creativity, audience interaction, practical skills and humour.
The British Association of Behavioural and Cognitive Therapies (BABCP) awarded Padesky an Honorary Fellowship in 2017.
In addition, she is recipient of BABCP’s Most Influential International CBT Therapist award, the California Psychological Association’s Distinguished Contribution to Psychology award, and the Academy of Cognitive Therapy’s Aaron T. Beck Award for her enduring contributions to the field.
Padesky is co-author of five books, including Mind Over Mood, 2nd Edition (www.mindovermood.com). With over a million copies sold world-wide in 23 languages, the first edition was named the most influential CBT book of all time by BABCP and was an inaugural winner of the Book of Merit award from ABCT. The second edition of Mind Over Mood was 2nd place winner of the 2016 American Journal of Nursing Book of the Year Award, Consumer Health Category. Two more books await publication — the Clinician’s Guide to Mind Over Mood, 2nd Edition (in press, Guilford Publications, with Dennis Greenberger) and a book on Socratic methods and guided discovery processes in CBT (publication expected 2020, Oxford University Press, co-edited with Helen Kennerley). Her other books include Collaborative Case Conceptualization (co-authored with Kuyken and Dudley).
Kazantzis, N., Fairburn, C.G., Padesky, C.A., Reinecke, M., & Teeseon, M. (2014). Unresolved issues regarding the research and practice of cognitive behaviour therapy: The case of guided discovery using Socratic Questioning. Behaviour Change, 3, 1-17.
Padesky, C.A. (1993, September). Socratic questioning: Changing minds or guiding discovery? Invited keynote address presented at the 1993 European Congress of Behaviour and Cognitive Therapies, London. [available from https://www.padesky.com/clinical-corner/publications/]
Padesky, C. A. & Mooney, K.A. (2012). Strengths-based Cognitive- Behavioural Therapy: A four-step model to build resilience. Clinical Psychology & Psychotherapy, 19 (4), 283-90. [available from https://www.padesky.com/clinical-corner/publications/]