In-Congress Workshops

Registration for In-Congress Workshops

The cost of each in-congress workshop is £30 for members and non-members and £20 for students and people from Emerging Countries.

Payment needs to be made online by clicking on the blue button below.

 

Register for In-Congress Workshops

Thursday 9th September 14.00 – 17.00 GMT (15.00 – 18.00 CET)

Workshop 1: Cognitive-behavioural chairwork from the ‘inside-out’: An introductory selfpractice / self-reflection workshop.

Matthew. Pugh, Central and North West London NHS Foundation Trust, UK and Tobyn Bell, University of Manchester, UK

‘Chairwork’ refers to a collection of powerful experiential interventions which utilise chairs, their positioning, movement, and dialogue for therapeutic purposes. Broadly speaking, the aim of chairwork is facilitate transformative, here-and-now interactions with parts of self, including distressing patterns of thought, feelings, and behaviour.

Chairwork has a rich history of applications in CBT and allied approaches including Compassion-Focused Therapy, Schema Therapy, and Trial-based Cognitive Therapy. In line with theories of cognitive science, preliminary research suggests that chairwork is an effective therapeutic method which is distinguished by its evocative, immersive, and multisensory qualities.

Studies indicate that one of the most effective ways for therapists to refine their skills is through self-practice and selfreflection (SP/SR). This workshop offers participants the unique opportunity to learn cognitive-behavioural chairwork in an immersive manner, from the ‘inside out’. In doing so, a three-dimensional experience of therapy is created, providing insights into the client’s experience, enhancing reflective capabilities, and integrating conceptual knowledge and technical skills.

The workshop will focus on developing competence using chairwork through self-experiential learning, with a focus on addressing self-criticism. Participants will have the opportunity to work on either ‘therapist’ or ‘personal’ issues. Participants will be introduced to a range of chair-based methods including empty-chair, multi-chair, interview, and roleplay techniques.

Objectives: By the end of the workshop, participants will be able to:

  • Describe core forms of chairwork utilised in CBT including empty-chair, multi-chair, and role-playing techniques.
  • Appreciate the relative strengths and weaknesses of these techniques, with reference to theories of information processing.
  • Utilise chairwork techniques to assess, manage, and conduct functional analyses of self-criticism.
  • Apply process-based skills to maximise the effectiveness of chairwork.
  • Overcome common obstacles when using these techniques.

Experiential interventions such as chairwork are recommended when ‘standard’ cognitive-behavioural techniques prove ineffective (Beck, 1995), emotional change is limited (Goldfried, 1988), or cognitions are deeply entrenched (Ellis, 2001).

Research also suggests that chairwork is a memorable and clinically-effective method for addressing self-criticism. Accordingly, these techniques are able to enhance cognitive-behavioural practice and represent a valuable addition to therapists’ technical repertoires. This is not to say that chairwork is without limitations – further research is needed to ratify its efficacy and mechanisms of action

Matthew Pugh is a Clinical Psychologist, Cognitive Behavioural Psychotherapist, and Schema Therapist. He works at the Vincent Square Eating Disorders Service (CNWL) and is a Clinical Lecturer with UCL. He is the author of ‘Cognitive Behavioural Chairwork: Distinctive Features’ and has facilitated popular chairwork workshops with several BABCP branches with Tobyn Bell.

 Tobyn Bell is a Cognitive Behavioural and Compassion-Focused Therapist, and is part of the training executive for the Compassionate Mind Foundation. He is the co-author of the book ‘Compassion Focused Therapy from the Inside Out: A Selfpractice/Self-reflection Workbook for Therapists’. He is also a CBT trainer supervisor.

References:

Bell, T., Montague, E., Elander, J., & Gilbert, P. (2019). “A definite feel-it moment”: Embodiment, externalization and emotion during chair-work in compassion-focused therapy. Counselling and Psychotherapy Research, 20, 143-153.

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

Pugh, M. (2020). A little less talk, a little more action: A dialogical approach to cognitive therapy. The Cognitive Behavioural Therapist, 12, 1-24

 

Workshop 2: Unravelling the Chain – DBT Chain and Solution Analysis with Adults and Adolescents

Marie Wassberg, MW Care, Training & Consultancy Ltd, UK and Catherine Parker, Private Practice, UK

The DBT treatment programme was developed by Marsha Linehan for the treatment of Borderline Personality Disorder over 30 years ago.  Since then, there have been numerous studies exploring and validating this approach for different populations.  Currently, DBT is cited by NICE as a treatment of choice for women with a diagnosis of BPD who self-harm. This approach is based on a formulation which hypothesises the reinforcement of dysfunctional and self-damaging behaviours and a deficit in self-management skills, particularly in emotion regulation.

At the core of DBT is a central dialectic – Acceptance vs Change – and all its treatment strategies aim to resolve this dialectic during the course of therapy. This workshop will introduce the DBT formulation and will focus on one of the key treatment strategies to promote change, the Chain and Solution Analysis. This strategy is primarily used in individual DBT therapy to examine target behaviours with a view to reducing dysfunctional and increasing functional behaviours.

During the course of therapy, behavioural targets are identified and when they occur, are subjected to a detailed analysis informed by Behaviour Theory. Solutions can then be collaboratively explored to change behaviour patterns and to reinforce the effective application of DBT skills.

We will briefly discuss the particular individual and group processes involved in working with both adults and adolescents who present with dysregulation problems.  The process of chain analysing will be introduced and demonstrated in a case study.  The systematic changing of behaviour and the 4 sets of DBT skills will then be outlined before returning to apply these in developing solutions to the chain.   Consistent with dialectical philosophy which underpins DBT, we will demonstrate how acceptance strategies, such as validation, are also embedded in the process of change.

There will be demonstrations of DBT skills teaching, and a chance for some in-session practice.  We welcome clinicians with no prior DBT experience, as well as those who would like to brush up on their DBT skills.

Objectives:  To introduce the Chain Analysis and Solution Analysis strategy in the context of the DBT formulation, which hypothesises the reinforcement of dysfunctional behaviour together with skills deficits in the development of emotion regulation problems.

While DBT was initially developed for patients with Borderline Personality Disorder, many of its principles and practical interventions have been used trans-diagnostically to good effect.

The Chain Analysis is a strategy which applies Behaviour Theory to understand how complex behavioural and emotional difficulties are manifested, with a comprehensive store of behavioural solutions and practical skills to identify and implement an effective Solution Analysis.  DBT takes a very practical and accessible approach to increase client selfmanagement and effectiveness in both individual and group contexts.  It is possible, therefore, to integrate a DBT-informed approach into standard CBT in a wide range of applications.

Marie has been a DBT Therapist since 2010 and CBT therapist since 2003. She is also trained in Trauma Focused-CBT, incl Supervisor training; Prolonged Exposure; DBT for Schools; and EMDR. Marie qualified as a social worker in 1998 and has experience of working in the profession in both Sweden and England. Marie has been involved with developing DBT- informed programmes in different settings for children, adolescents and young adults. Today she offers individual and group therapy as well as supervision.  

Catherine completed the DBT intensive programme in 2001. She was one of the founder members of the Derbyshire DBT Service. For over 15 years, she delivered the full DBT programme, incl DBT skills groups, for adults with Borderline Personality Disorder. During this time, she delivered DBT workshops within her NHS Trust and local university. Catherine’s core profession is social work and practiced as an ASW for many years. 2008 she qualified as a CBT therapist.

References:

DBT Skills Training Manual, Second Edition by Marsha Linehan (Guilford Press, 2014)

DBT Skills Manual for Adolescents by Jill Rathus  & Alec Miller (Guilford Press, 2015)

Friday 10th September 09.00 – 12.00 GMT (10.00 – 13.00 CET)

Workshop 3 : Supervision of Supervision: conceptual basis & practical delivery

Peter Armstrong, Northumbria University, UK

While it has long been recognised that there is great difficulty in establishing an empirical basis for the practice of clinical supervision (Scaife 2019, Roth & Pilling 2015, Milne et al 2011), there are the beginnings of evidence (Milne 2017, 2009; Schoenwald et al 2009) that supervision adhering to key principles affects supervisee behaviour and clinical outcomes, and there remains an strong consensus across professions ad therapies that quality supervision is integral to safe and effective treatment. There is also good expert consensus that CBT supervision should reflect in its style, structures and methods the approaches that are characteristic of the therapy (Beck J 2015, Padesky 1995).

Whereas, historically therapists tended to be inducted into the corps of supervisors by some unspecified rating of their seniority or by the practical demands of clinical and training departments, there has been increasing awareness of the need for coherent training in and ongoing support for supervisors, including supervision of supervision (Milne, ibid; Townend et 2002).

What form should such supervision-of supervision (SVoSV) take? Which common elements should it share with direct clinical supervision and the therapy supervised therein? And what differences should there be?

The key common element that this workshop will explore is the principle that Cognitive & Behavioural Therapies are and should be guided by coherent models. In therapy these reflect processes relevant to health problems therapists are aiming to alleviate. In clinical supervision, supervisors draw on these to help guide the practice of their supervisees, and may in addition draw on a model of clinical supervision (e.g. Milne, Ibid; Holloway 2016; Hawkins & Shohet 2012, Armstrong & Freeston 2005) to guide their own practice, but these models themselves are unlikely to form the actual focus of the supervision itself, except where the supervision is under review (e.g. at contracting, or in addressing an alliance rupture). This of course, is as it should be in that the primary focus of clinical supervision should be on the needs of clients and supervisees. In SVoSV the position changes: since it is supervisory practice itself that is the focus of the activity, these are the models that should serve as the guide.

Objectives:

For attendees to:

  • Gain a working knowledge of relevant supervision models for application in SVoSV
  • Use said models to reflect on current practice and as a basis for refining future practice
  • Use selective examples and/or aspects of supervision models to problem-solve difficulties in supervision
  • Via reference to selected models, to differentiate guides to individual supervision practice from guides to the broader development of supervisory capacity in individuals and services

While key authorities in this field (e.g. Milne, Townend) have long advocated SVoSV, it is yet to become a routine aspect of practice in the field. A notable exception to this has been the CYP-IAPT project in which supervisors are trained in parallel with trainee therapists, and supervision of their supervision is a key element of their training. the workshop is conceived of as promoting this approach to the wider field of clinical supervision

Peter Armstrong, RMN & CBT practitioner, was closely associated with the group that developed the Revised Cognitive Therapy Scale (CTS-R), worked with Mark Freeston in developing the Newcastle ‘Cakestand’ model of clinical supervision, and collaborated with Derek Milne in work preceding his SAGE measure of  clinical supervision competence. He was a therapist, teacher, supervisor and head of training at the Newcastle Cognitive & Behavioural Therapies Centre and has taught widely in other training institutions and universities across the UK and beyond. He has worked into the supervision component of Northumbria University’s CYP-IAPT programme since its inception in 2013.

References:

Milne, DL. Evidence-Based CBT Supervision: principles and practice. Wiley 2018

Scaife, J. Supervision in clinical Practice. Routledge 2019

Roth, AD & Pilling, S.  A competence framework for the supervision of psychological therapies.  UCL 2015.   Available at https://www.ucl.ac.uk/pals/sites/pals/files/background_document_supervision_competences_july_2015

Workshop 4: Addressing sleep problems and fatigue in young people

Maria Loades, University of Bath, UK and Faith Orchard, University of Sussex, UK

Fatigue and sleep difficulties (e.g. insomnia) are common in adolescents with mental health problems such as depression and anxiety. Both may be precursors to developing mental health problems, and/or may remain as residual symptoms after treatment for mental health problems, potentially posing a vulnerability to relapse.

There is growing evidence that the treatment of sleep disturbances and/or fatigue can both improve and prevent symptoms of anxiety and depression. Furthermore, evidence has suggested that treatments for anxiety and depression often do not alleviate fatigue and/or sleep disturbances and this may result in a risk of future relapse. Training in the delivery of sleep and fatigue interventions is not always included in CBT courses, but there is growing evidence of the importance of primary sleep and fatigue interventions, but also adjunct treatment modules. Developing skills in the delivery of sleep and fatigue interventions for adolescents will enable clinicians to work with a broader range of symptoms. As these difficulties are transdiagnostic, we anticipate that this will be of interest and relevance to a diverse range of practitioners.

The effect of insomnia is widespread across a range of behaviours and emotions. CBT for insomnia is effective at reducing difficulties getting to sleep, staying asleep and waking up too early, as well as increasing total sleep time. CBT-I is effective with adolescents, and has been found to also improve symptoms of depression and anxiety. CBT-I includes a range of techniques for improving sleep, these include: Psychoeducation, Sleep monitoring, Thought-challenging, Sleep hygiene, Stimulus Control and Sleep Restructuring (Restriction)

Biological processes (e.g. a virus or disease) and/or environmental stressors, such as stressful events, may trigger the onset of fatigue. It is then maintained by cognitive factors, such as illness perceptions and beliefs about the controllability and predictability of the symptoms, emotional factors such as depression and anxiety and behavioural responses to fatigue such as over-exertion or excessive rest. CBT for fatigue (CBT-F) has been found to improve fatigue and physical functioning in a range of patient populations.

CBT-F involves:

  • Sleep management following the CBT-I approach
  • Activity management
  • Thought challenging
  • Shifting attentional focus away from fatigue
  • Behavioural experiments

In this workshop, we will summarise the evidence base for both CBT-I and CBT-F in adolescents. We will describe how to assess fatigue and sleep problems, and what both treatments entail, including through brief demonstration role plays. Participants will have the opportunity to practice these skills as applied to cases they are working with/case studies we will provide.

Objectives: Participants will develop understanding and skills in the following areas:

  • Understand the importance and biology of sleep and fatigue, and how sleep and fatigue change during adolescence
  • Be able to identify common patterns of sleep disturbance and fatigue, particularly in relation to anxiety and depression
  • Learn about the different measurements of sleep and fatigue, and be able to interpret sleep and activity diaries
  • Identify appropriate fatigue management and sleep hygiene practices, and how to adapt for adolescents and families
  • Design and implement a sleep schedule using sleep diaries and calculations, and an activity management programme using activity diaries.

Maria Loades is a Senior Lecturer at the University of Bath. She is a Clinical Psychologist with extensive experience of working in CAMHS, and currently holds an NIHR doctoral research fellowship focusing on depression in paediatric Chronic Fatigue Syndrome (CFS). 

Faith Orchard is a Lecturer in Psychology at the University of Sussex. She is investigating sleep difficulties as a predisposing factor and a treatment target in adolescent depression. She has recently adapted CBT-I for adolescents and has been piloting this intervention in various forms (face-to-face, workshops, schools). 

References:

Loades, M.E. & Chalder, T. (in press). Chronic fatigue in the context of paediatric physical and mental illness. In E. Taylor, F, Verhulst, A. Nikapota, K. Yoshida & J. Wong (Eds.). Mental Health and Illness Worldwide: Mental Health and Illness of Children and Adolescents. Springer.

Workshop 5: Identifying the focus for PTSD intervention with service users within Early Intervention for Psychosis (EIP) services

David Keane, Debra Malkin, Fillipoo Varese and Gita Bhutani, Lancashire and South Cumbria NHS Trust, UK

The relationship between trauma and psychosis is well established. There is large amount of overlap between the ICD/DSM diagnostic criteria for Post-traumatic Stress Disorder (PTSD) and psychosis and/or schizophrenia. In spite of the level of comorbidity and the evidence for the links and underlying mechanisms, trauma is rarely a focus of intervention in psychosis and psychosis has often been on the list of exclusion criteria for research studies on PTSD.

Two trauma-focused psychological therapies have a strong evidence base supported by meta-analyses: Trauma-Focused

Cognitive Behavioural Therapy (TFCBT) and Eye Movement Desensitization and Reprocessing (EMDR). Both TF-CBT and EMDR include exposure techniques that involve recalling traumatic events with accompanying cognitions, emotions and bodily sensations to promote amelioration of distress and trauma-related symptoms. The application of such techniques to clients with psychosis often involves additional challenges.

This workshop will present a framework to support therapists in in enabling them to assess and address traumatic experiences and memories appropriately without destabilising service users presenting with symptoms of psychosis.  It will include guidance on linking the memory target selection with the client defined priority problem and associated goal.  This will include understanding of the mechanisms of trauma-focused therapy in psychosis and identifying the barriers to meaningful engagement.   Principles around acceptability and choice for service users will be described in relation to trauma-focused approaches in this population.

Objectives:

  • Understanding of the principles of trauma-focused therapy in psychosis
  • Identifying clients who can benefit from this approach
  • Identifying the traumatic experiences and memories on which to focus
  • Eliciting cognitions and beliefs which are trauma-focused and do not maintain psychotic beliefs

TFCBT and EMDR are the primary treatments for PTSD recommended by NICE (2018).  NICE (2014) also emphasises the need for PTSD assessment for clients who access EIP services.  Trauma-focused interventions in the context of psychosis require further development and recognition of the complex interaction between traumatic experiences and life events.  Approaches that can improve outcomes and treatment acceptability efficiently are important for service user choice in NHS services.

David Keane and Debbie Malkin are Senior Cognitive Behavioural Psychotherapists and EMDR Consultants within

Lancashire Traumatic Stress Service.  They are currently involved in an RfPB funded research trial looking at the feasibility of EMDR-P for Psychosis.

References:

Ward-Brown, J., Keane, D., Bhutani, G., Malkin, D., Sellwood, B., & Varese, F. (2018). TF-CBT and EMDR for young people with trauma and first episode psychosis (using a phasic treatment approach): Two early intervention service case studies. The Cognitive Behaviour Therapist, 11, E17. doi:10.1017/S1754470X18000193

Varese, F, Sellwood, W, Asseem, S, Awenat, Y, Bird, L, Bhutani, G, Carter, L-A, Davies, L, Davis, C, Horne, G, Keane, D, Logie, R, Malkin, D, Potter, F, van den Berg, D, Zia, S, Bentall, R. (2020) Eye movement desensitisation and reprocessing therapy for psychosis (EMDRp): Protocol of a feasibility randomized controlled trial with early intervention service users.  Early Intervention in Psychiatry,  https://doi.org/10.1111/eip.13071

Friday 10th September 14.00 – 17.00 GMT (15.00 – 18.00 CET)

Workshop 6: Working from the future back. Positive CBT:  the individual and group treatment protocols

Fredrike Bannink,  the Netherlands

Instead of going back to the future – as is the theme of this congress – Positive CBT is working from the future back.  Positive CBT integrates positive psychology and solution-focused brief therapy within a cognitive-behavioral framework. It focuses not on reducing what is wrong, but on building what is right.

In this interactive workshop Fredrike presents her model of Positive CBT and the research and practice of the individual and group treatment protocols.

Objectives:

After the workshop the attendants will have:

  • knowledge of positive CBT and how it differs from traditional CBT
  • an overview of the two treatment protocols – for individual and group therapy.
  • skills to enhance positive emotions and have more hopeful and optimistic conversations.
  • a few practical positive CBT tools (e.g. positive Functional Behavior Analysis; FBA).

Positive CBT offers the best constructive vision to date of what CBT can look like when joined with positive psychology and solution-focused brief therapy approaches. It captures the essential importance of building on positive feelings, motives, imagery, memories and behaviors.  It changes what we focus on and how we work in helping people change.

Dr. Fredrike Bannink MDR is a clinical psychologist and lawyer. She is a trainer and supervisor of the Dutch Association for Behavioral and Cognitive Therapies and founder and chair of the Dutch Positive CBT section and EABCT’s SIG Positive CBT. She is an international keynote speaker, trainer and author of around 50 books. www.fredrikebannink.com

References:

Bannink, F.P. (2012). Practicing Positive CBT. Oxford: Wiley-Blackwell.

Bannink, F.P. & Geschwind, N. (2021). Positive CBT: Individual and Group Treatment Protocols. Boston: Hogrefe Publishing Group.

Geschwind, N., Arntz, A., Bannink, F. & Peeters, F. (2019). Positive cognitive behaviour therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behaviour therapy. Behaviour Research and Therapy, 116, 119-130.

Geschwind, N., Bosgraaf, E., Bannink, F. & Peeters, F. (2020). Positivity pays off: Clients’ perspective on positive compared with traditional cognitive behavioral therapy for depression. Psychotherapy, 57, 3, 366-378.

Workshop 7:Training Emotion Regulation in Children & Adolescents (EuREKA)

Laura Wante and Elisa Boelens, Ghent University, Belgium

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

EuREKA is a promising and transdiagnostic treatment program that can be added to the standard CBT to improve emotion regulation skills in adolescents with various form of psychopathology

Objectives:

Participants will be able to:

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

Laura Wante is a postdoctoral researcher at Ghent University. Her research focuses on the evaluation of a new training focused on emotion regulation and cognitive control in depressed adolescents. Next to her research activities, Laura works as a clinical psychologist at the University treatment center for children and adolescents. 

 

Elisa Boelens is doing her PhD at the Department of Developmental, Personality and Social Psychology at Ghent University where she is working on a research project on investigating and training emotion regulation in youth. Furthermore, she is a clinical psychologist working with children and adolescents with both internalizing and externalizing problems.

References:

Berking, M., & Lukas, C. A. (2015). The Affect Regulation Training (ART): a transdiagnostic approach to the prevention and treatment of mental disorders. Current Opinion in Psychology, 3, 64-69.

Debeuf, T., Verbeken, S., Boelens, E., Volkaert, B., Van Malderen, E., Michels, N., & Braet, C. (2020). Emotion regulation training in the treatment of obesity in young adolescents: protocol for a randomized controlled trial. Trials, 21(1), 153.

Volkaert, B., Wante, L., Vervoort, L., & Braet, C. (2018). ‘Boost Camp’, a universal school-based transdiagnostic prevention program targeting adolescent emotion regulation; evaluating the effectiveness by a clustered RCT: a protocol paper. BMC public health, 18(1), 1-14.

Workshop 8: Acceptance and Commitment Therapy and the Self

Louise McHugh, University College Dublin, Ireland

Did ever feel it wasn’t okay to be you, just as you are? Do you often see yourself in a particular light, whether positive or negative? Do you have clients struggling with these issues? The most important relationship any individual has is with themselves as it underlies all others. Any wounds or fixed ways of seeing yourself will hinder your relationships with others. A healthy flexible relationship with yourself is almost universally seen as a prerequisite for sound mental health. When we work with clients on their relationship with their self, one key aim is to help them to be at peace with themselves, and let go of rigid ideas of who they are.  In this workshop you will learn how we get caught up in our ‘selves’ and practices for disentangling ourselves from such behaviour. The current workshop will explore the Acceptance and Commitment Therapy process referred to as Self as Context that fosters a healthy sense of self and flexible perspective taking. The workshop will provide a conceptual overview of self-as-context, focusing on how it applies to improving psychological problems. The workshop will involve interactive exercises to support integrating Self as Context work into your existing clinical practice.

Saturday 11th September 09.00 – 12.00 GMT (10.00 – 13.00 CET)

Workshop 9: Inference Based Approach: Treating Obsessive Compulsive Disorder in a nonfrightening way

Henny Visser, GGzCentraal, the Netherlands and Shiu FungWong, UNSW Sydney, Austalia 

Not being able to hold your young child because you fear you might abuse it sexually. Losing your job because you repeatedly do not show up on time due to compulsively checking the stove and door locks. Ruining your skin and night’s rest because you constantly doubt whether you are clean enough even after hours of washing. These and other examples of Obsessive Compulsive Disorder (OCD) are extremely disabling. CBT outperforms other treatments for OCD, however, approximately half of the patients still meet DSM-5 criteria for OCD after this treatment. Furthermore, some patients refuse CBT or drop-out early because they find it extremely frightening and unacceptable. So, innovative and nonfrightening interventions for OCD are sorely needed. The Inference Based Approach (IBA) is a new evidence-based cognitive treatment for OCD. No exposure with response preventions is part of IBA and its focus is on resolving obsessional doubt.

Obsessional doubt forms a part of obsessional thinking in most subtypes of OCD, where the person doubts actions, information, or the self, and ruminates excessively on the chance that harm, error or other mishap ‘may’ occur/have occurred. The IBA model states that ‘inferential confusion’ creates obsessional doubt. IBA is a 10-step manualized treatment delivered in an individual format. The goal of the treatment is overcoming inferential confusion, which involves reorienting the person to trusting the senses, self, and common sense, and relating to reality in a normal, non-effortful, and non-obsessive way.

The IBA postulates that individuals with OCD use a different reasoning style in OCD situations, that they go beyond information provided by the senses in the here and now to make an inference about a possible state of affairs (“Perhaps the door is not locked properly”). These reasoning devices are situated within an obsessional narrative, which is ultimately a product of the imagination, personal experience, hearsay, out-of-context facts and ideas, and abstract general rules. These reasoning devices  are hypothesized to be specific to OCD and OCD-like disorders. IBA aims to progressively modify doubting and obsessional inferences.

In the workshop, empirical studies supporting the IBA model will first be presented. IBA clinical strategies will then be described in detail using clinical case illustrations and audience interaction. A step-by-step outline of the IBA program will be provided, including identifying the doubting inference, soliciting the background reasoning narrative, unravelling the accompanying reasoning processes, and modifying the inference by replacing remote narratives with reality sensing. Distinctions between IBA and traditional CBT will be demonstrated.

Objectives:

  • Step-by-step illustration of the IBA program using case illustrations and audience interaction will teach attendees to approach OCD differently. They will recognize that their patients’ fear of specific consequences (e.g., fire, burglary) result from particular states of affairs (i.e., stoves left on, doors left unlocked) that are inferred to be true based purely on the imagination and not the current context (i.e., stove is actually off, door is actually locked). The audience will also learn how to identify these doubting inferences and to modify these by unravelling their supporting reasoning processes and through reality sensing.
  • Attendees will gain knowledge of empirical research supporting the IBA model.

Dr. Henny Visser is a psychotherapist (CBT supervisor) in the Netherlands and principal investigator of an ongoing multicentre randomized controlled trial investigating effectiveness of and brain response to IBA and CBT among patients with OCD. She leads the anxiety and compulsive disorders research program at her institution.

Dr. Shiu Fung Wong is a lecturer in clinical psychology in Australia and a collaborator of an ongoing large randomized controlled trial, funded by the Canadian Institutes of Health Research, investigating ways to improve the acceptability of treatments for OCD.

References:

Visser, H., van Megen, M., van Oppen, P., Eikelenboom, M., Hoogendoorn, A., Kaarsemaker, M., & van Balkom, A. (2015). Inference-Based Approach versus Cognitive Behavioral Therapy in the treatment of Obsessive-Compulsive Disorder with poor insight: A 24-session randomized controlled trial.

Psychotherapy and Psychosomatics, 84, 284-293. doi:  10.1159/000382131

Strauss, A., Fradkin, I., McNally, R., Linkovski, O., Anholt, G., & Huppert, J. (2020). Why check? A meta-analysis of checking in obsessive compulsive disorder: Threat vs. distrust of senses. Clinical Psychology Review, 75, 101807. doi: 10.1016/j.cpr.2019.101807

Julien, D., O’Connor, K., & Aardema, F. (2016). The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change. Journal of Affective Disorders, 202, 187-196. doi: 10.1016/j.jad.2016.05.060

Workshop 10: Contextual Behaviour Therapy to Target Sexual and Gender Minority Stress Processes.

Matthew Skinta, Roosevelt University, USA and Aisling Leonard-Curtin, Act Now Purposeful Living, Dublin, Ireland

Since Pachankis and colleagues (2015) randomised controlled trial of an intervention targeting minority stress, increasing attention has been paid to the benefit of targeting underlying factors that affect sexual and gender minority (SGM) clients. This has included adaptations of acceptance & commitment therapy (ACT), functional analytic psychotherapy (FAP), dialectical behaviour therapy (DBT), and a growing literature on self-compassion interventions in bolstering resilience. This workshop will emphasise process-based behavioural techniques drawn from ACT, FAP, and Compassion-Focused Therapy that take advantage of research on minority stress and emotion regulation. The workshop will incorporate both theoretical and experiential work. Moving through life as an SGM person often entails some period of secrecy, guardedness, shame, and familial ruptures. We will explore the therapeutic techniques that tackle these concerns in the therapy hour and within the therapeutic relationship. This workshop will also aid clinicians in cultivating their own compassion and values toward meeting the challenges of moving through life as an SGM person, particularly through targeting the therapist’s own history of cultural messages about gender and sexuality. Through the use of awareness, courage, therapeutic love, compassion, perspective-taking, and acceptance, participants will grow in their ability to relate as gendered and sexual beings. From this place, powerful and therapeutic relationships can blossom. Clinician’s will leave with a greater understanding of how concepts such as minority stress, rejection sensitivity, and shame can be better responded to in session. Particular attention will be made toward the cultural and global concerns that arise as both acceptance and animus are on the rise globally toward SGM communities.

Objectives:

  • Describe and learn how to conceptualize SGM issues from the perspective of Acceptance & Commitment Therapy and Functional Analytic Psychotherapy.
  • Explain and experience functional contextually-based experiential exercises in the area of learning histories related to gender identity & sexuality.
  • Improve case conceptualisation skills when minority stress processes are a better clinical target than traditional diagnostic categories.

Sexual and gender minority clients are more likely to seek help from therapists, yet therapists are unlikely to have received specific training in affirmative models that consider the affect of societal bias toward SGM individuals and specifically target minority stress processes. Deepening ones knowledge and skills in this area will enhance a clinicians ability to meet the needs of their clients.

Matthew Skinta, PhD, ABPP, is an Assistant Professor at Roosevelt University in Chicago, USA. Dr. Skinta is a peer-reviewed Acceptance & Commitment Therapy (ACT) trainer, as well as a certified Functional Analytic Psychotherapy (FAP) trainer and Compassion Cultivation Training (CCT) teacher. He provides workshops, training, and consultation around the globe.

Aisling Leonard-Curtin, MSc, is a chartered counseling psychologist with the Psychological Society of Ireland. She is codirector of Act Now Purposeful Living, has a small private practice, and regularly gives workshops internationally. She is a peer-reviewed acceptance and commitment therapy (ACT) and functional analytic psychotherapy (FAP) trainer.

References:

Skinta, M. D. (2020). Contextual Behavior Therapy for Sexual and Gender Minority Clients: A Practical Guide to Treatment. Rou tledge. Skinta, M. D. & Curtin, A. (2016), Mindfulness and Acceptance for Gender and Sexual Minorities: A Clinician’s Guide to Fostering Compassion, Connection, and Equality Using Contextual Strategies. Oakland, CA: New Harbinger Publications.

Skinta, M. D., Hoeflein, B., Muñoz-Martínez, A. M., & Rincón, C. L. (2018). Responding to gender and sexual minority stress with functional analytic psychotherapy. Psychotherapy, 55(1), 63-72.

 

Workshop 11: Unearthing stakeholder attitudes: using Q methodology to sample diverse views and guide service provision

Anja Wittkowski and Lynsey Gregg. University of Manchester, UK 

The workshop will provide an overview of Q methodology (Stephenson, 1935, 1953) and its uses, outlining its utility for use in research and within health care services as a way of capturing a broad range of stakeholder views.

Considered a ‘mixed’ method, Q methodology seeks to capture subjective viewpoints and analyse them quantitatively via an inverted form of factor analysis, as well as qualitatively. It is essentially a sorting technique, in which participants rank items (usually statements, but also images). Factor analysis is used to unearth distinct views and to group participants according to their shared perspectives. As such Q methodology may point towards a consensus of opinions.

Q methodology is widely used in education, health economics and social policy and is increasingly recognised as a valuable approach in Clinical Psychology.

The presenters will offer an introduction to Q methodology and outline its utility in exploring the beliefs and attitudes of various stakeholders, including adult mental health practitioners, other health care professionals, service users, parents and carers. Its potential for use in NHS settings (therapeutically and as an evaluation tool) will be discussed along with exploration of how it can be used to improve NHS service provision more generally (in terms of both service user engagement, and delivery of services).

We will cover the key steps of a “Q study” giving detailed guidance on all aspects from designing an appropriate question, to writing up results. We will explain how to identify and choose the statements to be sorted, who to sample, and how to analyse and interpret the responses once collected. We will also discuss the use of post-sort interviewing and the relative merits of face to face or more distal methods (online postal).

We will use examples from our published studies to illustrate our points and offer insights on the use of this methodology in health, clinical and research settings.

Workshop participants will gain a deeper understanding of this methodology and how it could be used to improve service delivery through the in-depth exploration of views and attitudes held by a range of stakeholders, including service users, health care professionals, practitioners and managers. There is the potential to assess current opinion held by a group, explore consensus across views and evaluate change, for example in MDTs following the implementation of new working practices or new guidance.

Participants will:

  1. Gain a thorough understanding of the principles of Q methodology
  2. Understand the opportunities that Q methodology presents, and the limitations of its administration
  3. Be knowledgeable about the selection of statements and identification of participants
  4. Understand how to analyse the data using factor analysis, and how to interpret the resulting factors

Dr Anja Wittkowski, Senior Lecturer in Clinical Psychology and practicing psychologist for Manchester’s Mother and Baby Unit, has expertise in perinatal mental health and parenting.

Dr Lynsey Gregg, Lecturer in Clinical and Health Psychology, brings expertise in psychosis research and in quantitative and mixed methodologies.  

Both presenters are affiliated with the Division of Psychology and Mental Health at the University of Manchester and Co- Directors of GMMH’s Perinatal Mental Health and Parenting Research Unit. Both have extensive postgraduate teaching experience and have published at least ten papers utilising Q methodology to explore the attitudes of health care professionals and service users.  

References 

Watts, S. & Stenner, P. (2012). Doing Q-methodological research: Theory, method and interpretation. London: Sage.

Adderley, H., Wittkowski, A., Calam, R., & Gregg, L. (2020). Adult mental health practitioner beliefs about psychosis, parenting, and the role of the