Pre-Congress Workshops

The Pre-Congress Workshops will run from 9.30am to 5.00pm on Wednesday 8th September 2021.
Each workshop will last for seven hours including breaks. Delegates can register to attend in person in Belfast or can join online.

Workshop One

Imagery Rescripting in patients with personality disorders
Arnoud Arnzt, University of Amsterdam, the Netherlands

 

Imagery Rescripting is a powerful transdiagnostic technique by which memories of traumatic and other aversive events can be addressed. As a standalone technique, it has been tested and found effective in a number of RCTs in different disorders. In the treatment of personality disorders it is a standard ingredient of schema therapy and also often integrated in cognitive therapy. This workshop focusses on the application of Imagery Rescripting in patients with personality disorders. The main focus will lie on the use of Imagery Rescripting in processing memories of aversive/traumatic experiences in childhood that contributed to the personality problems. More specifically, the following issues will be addressed:

  • How to find relevant childhood memories, spec. the use of the affect bridge;
  • How to use Imagery Rescripting early in treatment: therapist rescripts;
  • How to use Imagery Rescripting later in treatment: patient rescripts from their present healthy point of view;
  • How to use Imagery Rescripting for other kinds of problems, such as how to prepare for difficult future events;
  • How to use Drama Rescripting in case patients have difficulties with imagery.

Most CBT techniques focus on the present and request change of behaviour or controlled thinking. Imagery Rescripting offers a powerful additional techniques for clinicians as it is suitable for helping patients changing by focusing on childhood experiences (learning history – focus on the past) and it is primarily an experiential technique, instead of behavioural or cognitive. Moreover, it is suitable for a range of complex emotions, including shame and guilt, and not restricted to fear related problems. Lastly, as the focus is on changing the meaning of underlying mental representations, it helps to bring about a fundamental change that will lead to reduced relapse.

Key learning objectives:

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

  • Apply the basic elements of Imagery Rescripting work in patients with personality disorders, which includes:
  • understanding the rationale of Imagery Rescripting;
  • detecting relevant childhood memories;
  • applying Imagery Rescripting in two basis forms;
  • deal with common problems in applying the technique;
  • think out applications to current / future problems of the patient.

Arnoud Arntz is professor of Clinical Psychology and chair of the Department of Psychology at the University of Amsterdam, the Netherlands. His main research interests lie in the fields of PTSD and personality disorders, 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 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 anxiety disorders, especially 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, of another multicenter RCT that compared ST to treatment as usual (TAU) and CCT for 6 other PDs, of an international RCT comparing Imagery Rescripting and EMDR for PTSD that originated from childhood traumas, and together with Dr Joan Farrell PI of the international RCT that compared group-ST to TAU for Borderline PD. He is currently PI of an international RCT that investigates the effects of session frequency on the effectiveness of Imagery Rescripting and EMDR as treatments for childhood trauma-related PTSD, and of a multicentre RCT comparing group-ST to individual ST and TAU as treatments for Cluster-C PDs.

References

Arntz, A. (2011). Imagery Rescripting for Personality Disorders. Cognitive and Behavioral Practice, 18, 466-481.

Arntz, A. (2015). Imagery Rescripting for Personality Disorders: Healing Early Maladaptive Schemas. In N.C. Thoma & D. McKay (Eds.) Working with emotion in cognitive behavioral therapy: techniques for clinical practice. (pp. 175-202). New York: Guilford Press.

Morina, N., Lancee, J., & Arntz, A. (2017). Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 55, 6-15.

 

Workshop Two

The paradox of thought control and other cognitive strategies in the treatment of OCD
Maureen L Whittal, PhD, Vancouver CBT Centre & University of British Columbia

Exposure and response prevention (ERP) is the gold standard psychological treatment for obsessive compulsive disorder (OCD). For those who complete treatment, 80-90% receive benefit. The average decline in symptoms is approximately 50%-60%, with relapse rates of less than 10%. Nevertheless, doing ERP can be difficult for some patients, and individuals with covert compulsions may pose a particular challenge for exposure-based treatments. Cognitive therapy (CT) strategies address some of the limitations of ERP, and appear to also be effective in reducing OCD symptoms. This workshop will focus on CT strategies for the different types of OCD symptoms (e.g., contamination, checking, severe obsessions, mental rituals, ordering rituals, etc.). Case studies and video examples will demonstrate the nuts and bolts of planning and implementing the treatments. Common obstacles to treatment, such as arguments and motivational problems, will be reviewed, and methods for addressing such problems will be provided.  If time permits an introduction to mental contamination will be provided.

Given that OCD has such a heterogenous presentation, it can be difficult to feel confident in recognising and conceptualising the various presentations of it. Moreover, patients entering treatment may not be ready for exposure and response prevention. Having a unified conceptualisation that focuses on the meaning of the thought can help clinicians and patients alike. Additionally, the focus on appraisal and the cognitive targeting of the meaning of unwanted intrusions provides additional tools to facilitate behavioural change. A cognitive approach would also dovetail with traditional exposure and response prevention. Outside research trials in everyday clinical practice, it is expected that treatment will involve a blending of these empirically supported approaches. Having familiarity with these cognitive approaches will add to the clinical toolbox to treat this often challenging presentation.

Key learning objectives:

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

  • Understand the how and why the development of cognitively-focused treatments occurred in the context of the gold standard exposure and response prevention (ERP)
  • Conceptualise cases using the appraisal model focusing on the meaning of unwanted intrusive thoughts
  • Identify cognitively-focused treatment strategies to address the overimportance and need to control thoughts, inflated responsibility and overestimations of threat.

Dr. Maureen Whittal received her Ph.D. in clinical psychology in 1995 from West Virginia University in the United States. Dr. Whittal is currently Clinical Associate Professor in the UBC Department of Psychiatry and is Adjunct Faculty in the UBC Department of Psychology. She is also the former Editor of Cognitive and Behavioral Practice, a scientific journal designed to bridge the gap between laboratory-based work and clinical practice. Dr. Whittal is an acknowledged expert in Cognitive Behavioral Therapy (CBT). She is certified by the Academy of Cognitive Therapy (ACT) and in 2003 received a year-long scholarship to train at ACT. Dr. Whittal also holds a Diplomate in CBT with the American Board of Professional Psychology, and is certified by the Canadian Association of Cognitive Behaviour Therapy. In 1999 Dr. Whittal co-founded Anxiety Canada, a non-profit organization that now receives approximately 2.5 million visits annually.

Dr. Whittal ran 3 treatment trials in OCD and has published numerous research articles and chapters. Dr. Whittal has also lectured and provided workshops to professionals across North America, the United Kingdom and Europe. Closer to home, Dr. Whittal has trained numerous psychologists and psychiatrists since 1996 in the assessment and treatment of anxiety disorders from a cognitive-behavioral perspective.

Key references

Yule, M., Whittal, M.L., & Robichaud, M. (in press). Cognitive Treatment for OCD. D.T. Tolin (Ed)., Oxford Handbook of Obsessive-Compulsive and Related Disorders. Oxford University Press.
Yule, M. & Whittal, M.L. (2017) Cognitive therapy for Obsessive Compulsive Disorder. C. Pittenger (Ed). Obsessive Compulsive Disorder: Theory and Application. Oxford University Press. Pp 421-430.
Rachman, S. J. (2003). The treatment of obsessions. Oxford: Oxford University Press.

David Clark

Workshop Three

Cognitive Therapy for Social Anxiety Disorder in Adults and Adolescents
David M Clark, Experimental Psychology, University of Oxford

Social Anxiety Disorder is common and remarkably persistent in the absence of treatment.  It typically starts in childhood or adolescence and frequently leads to occupational and education underachievement.  Interpersonal relationships are impaired.  Dissatisfaction with the way that life is progressing often triggers depressive episodes and there is a heightened risk of alcohol and drug abuse. A leading NICE recommended psychological intervention for social anxiety is cognitive therapy based on the Clark & Wells model. Randomised controlled trials in the UK, Sweden, Norway, Germany, Japan, and China have shown that this treatment is superior to exposure therapy, group CBT, interpersonal psychotherapy, psychodynamic psychotherapy, and medication.

The workshop provides a comprehensive practical guide to cognitive therapy for social anxiety disorder, with both adults and adolescents.  It starts with an overview of the cognitive model, focussing on its treatment implications.  Each of the steps in treatment is then described and illustrated with case material and videos of treatment sessions.  The key procedures include: deriving with patients an individualized cognitive model; demonstrating the adverse effects of self-focussed attention and safety behaviours through experiential exercises; video feedback and other procedures to correct excessively negative self-imagery; training in externally focussed, non-evaluation attention; behavioural experiments to test negative beliefs; and ways of dealing with socially relevant traumatic memories (discrimination training & memory re-scripting).  Guidance on the use of the most appropriate measures for identifying therapy targets and monitoring progress is also provided.

Social anxiety is the most common anxiety disorder and is commonly seen either alone or co-morbid with depression. Long term follow-ups show that the excellent results obtained with cognitive therapy for social anxiety disorder are well maintained many years later. As a consequence, the treatment genuinely transforms people’s lives.

Key learning objectives:

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

  • Identify the key psychological processes in maintaining social anxiety disorder
  • Develop an individual version of the cognitive model with their clients and
  • Be able to identify appropriate therapeutic strategies and be familiar with how to apply them

David M Clark is the Professor of Experimental Psychology at the University of Oxford. He is well-known for his pioneering work on the understanding and psychological treatment of anxiety disorders: especially panic disorder, social anxiety disorder, health anxiety and PTSD.  Recently, he has also focused on how to disseminate effective psychological treatments within healthcare systems and is one of the architects of the English Improving Access to Psychological Therapies (IAPT) programme. He is a Fellow of the UK Academies of Medical Sciences and Social Sciences, the British Association of Behavioural Psychotherapies, and the Association for Psychological Science (USA). He is also an Honorary Member of the Swedish and Dutch Cognitive Behaviour Therapy Associations. Honours include Distinguished Scientist / Lifetime Achievement Awards from the British, Canadian and American Psychological Associations. The latter described his work as “pure genius with a real-world application”.

Key references

  1. Clark, D.M. (2001) A cognitive perspective on social phobia. In R. Crozier and L.E. Alden (eds) International Handbook of Social Anxiety Wiley; Chichester, UK
    2. Layard, R. and Clark, D.M. (2014). Thrive: The Power of Psychological Therapy. Allen Lane
    (Penguin), London
    3. Social Anxiety section of www.oxcadatresources.com, which is a free therapist resources website.

Workshop Four

Running in the Family: Helping Anxious Parents to Raise Confident Children.
Sam Cartwright-Hatton, University of Sussex and Ben Laskey, The Psychology Partnership.

Anxious parents matter.  Their children are approximately twice as likely to develop an anxiety disorder as other children, and also at increased risk of developing other mental health problems. Despite this, we currently do nothing to help anxious parents to raise confident children.

We have developed a set of techniques to support anxious parents and maximise their chances of raising confident children. Some of the techniques are based on general positive parenting practice that can fruitfully be used by any parent, for example emotion coaching, play, ensuring good sleep, and calm, clear, consistent behaviour management skills. Other techniques are focused on the specific context of family anxiety, such as the potential for modelling anxiety and avoidance, and identifying areas where a child could miss learning opportunities (e.g. a child who has never been on public transport because of parent’s agoraphobia) and taking steps to mitigate the impact of these. Care is taken to tailor the information to the needs of an anxious audience, encouraging self-compassion and ‘good enough parenting’ throughout.

A recent randomised controlled trial of a one-day workshop for anxious parents, based on these techniques, produced excellent results: One year after the workshop, children whose parents were randomised to attend the workshop were 16% less likely to have an anxiety disorder than children whose parents were in the control group.

This workshop presents a selection of these techniques. The techniques are drawn from the research base and practice-based evidence and the research and theoretical underpinnings will be briefly described.  However, the skills class will be practically-focussed, with lots of live demonstrations and role plays, and a chance to think about how the techniques might be brought into clinicians’ own practice.

The workshop is suitable for clinicians working with anxious children, and for clinicians who work with anxious adults and who wish to support those clients in their parenting role.

Parents are often neglected in mental health services.

In children’s services, the focus is often (for good reason) very much on the child.  In adult services, the focus is (again for good reason) on the individual’s own mental health needs.

However, there is an increasing understanding of the role of parental anxiety on children’s wellbeing.  This workshop will give both adult and child practitioners some skills for reducing the intergenerational cycle of transmission of anxiety and for fostering children’s resilience.

Key learning objectives:

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

  • Start a conversation about children and about parenting with anxious parents.
  • Identify the main difficulties that arise for parents who are highly anxious.
  • Support parents in developing good basic, general parenting skills.
  • Support anxious parents in identifying the ‘parenting hotspots’ that arise as a result of their anxiety.
  • Support anxious parents in ‘rubbing the corners off’ the parenting hotspots that arise as a result of their anxiety.

Sam Cartwright-Hatton is a clinical psychologist and professor of clinical psychology at the University of Sussex. Her research is focussed on the intergenerational transmission of poor mental health and interventions for preventing this. She leads the Flourishing Families project at Sussex Partnership NHS Trust – a unique service focussing on the needs of adult mental health clients who are parents.

Ben Laskey is a clinical psychologist currently working in independent practice. He has worked for the universities of Manchester and Exeter and in clinical services in Suffolk, Cornwall and Salford. Ben has been interested in transgenerational family patterns for over 20 years. He specialises in complex assessment and in family anxiety. Ben has trained over 200 practitioners to work with family anxiety using the Timid to Tiger Program and has supported service development for family anxiety in Devon and Bristol.

Key references

From Timid to Tiger. A Practice Manual for Parenting the Anxious Child.  Sam Cartwright-Hatton with Ben Laskey, Deb McNally and Stewart Rust.  Wiley Blackwell.
Cartwright‐Hatton, S., Ewing, D., Dash, S., Hughes, Z., Thompson, E. J., Hazell, C. M., … & Startup, H. (2018). Preventing family transmission of anxiety: Feasibility RCT of a brief intervention for parents. British Journal of Clinical Psychology57(3), 351-366.

Anke Ehlers

Workshop Five

Cognitive Therapy for PTSD: Tailoring treatment to different cognitive themes
Anke Ehlers, Centre for Anxiety Disorders and Trauma, University of Oxford, UK

NICE (2019) and international treatment guidelines recommend of Cognitive Therapy for PTSD as a first-line treatment for posttraumatic stress disorder (PTSD). The treatment has been shown to be highly effective and acceptable to adults and young people (Duffy et al., 2007; Ehlers et al. 2003, 2005, 2013, 2014; Gillespie et al., 2002; Meiser-Stedman et al., 2016; Smith et al., 2007). Ehlers and Clark’s (2000) cognitive model of PTSD guides treatment. This model suggests that people with PTSD perceive a serious current internal or external threat that has two sources, excessively negative appraisals (personal meanings) of the trauma and / or its sequelae and characteristics of trauma memories that lead to reexperiencing symptoms. The problem is maintained by cognitive strategies (such as thought suppression, rumination, safety-seeking behaviours) that are intended to reduce the sense of current threat but maintain the problem by preventing change in the appraisals and trauma memory, and/or lead to increases in symptoms.

Cognitive Therapy for PTSD has three goals. First, the idiosyncratic personal meanings are identified and changed. Therapeutic techniques include identification of hot spots during the trauma and associated meanings, Socratic questioning, and behavioural experiments. Second, the trauma memory is elaborated.  Idiosyncratic personal meanings of the trauma are linked with information that makes them less threatening, using a range of techniques. In stimulus discrimination training, the patient learns to discriminate triggers of reexperiencing symptoms from the stimuli that were present during the trauma. Third, the patient experiments with dropping maintaining behaviours.

Treatment is tailored to the individual case formulation. The workshop will discuss how to develop a formulation with the client and how to tailor procedures to common cognitive themes in PTSD such as appraisals linked to guilt, shame, anger, loss and mental defeat. Techniques used in treatment are described and illustrated with case examples and videos. A workshop on memory work in CT-PTSD is available at https://oxcadatresources.com/ptsd-training-videos/ (free registration as a clinician is required).

Anke Ehlers is Professor of Experimental Psychopathology and Wellcome Trust Principal Research Fellow at the Department of Experimental Psychology, University of Oxford, UK. She is a co-founder of the Centre for Anxiety Disorders and Trauma at the Maudsley Hospital, London, and co-directs the Oxford Centre for Anxiety Disorders and Trauma. Anke Ehlers is a Fellow of the British Academy, Academy of Medical Sciences, the German Academy of Sciences Leopoldina, and Academia Europaea. Her main research interests are the anxiety disorders, in particular posttraumatic stress disorder, panic disorder, and social phobia. In her experimental work, she has established cognitive and psychophysiological factors that maintain these disorders. With her colleagues, she has developed and evaluated an effective psychological treatment for posttraumatic stress disorder. 

Key References

Duffy, M, Gillespie, K, & Clark, D.M. (2007). Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomised controlled trial. British Medical Journal, 334, 1147-50.  DOI: 10.1136/bmj.39021.846852.BE

Ehlers, A., & Clark, D.M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345. DOI: 10.1016/S0005-7967(99)00123-0
Ehlers, A., Grey, N., Wild, J., Stott, R., Liness, S., Deale, A., Handley, R., Albert, I., Cullen, D., Hackmann, A., Manley, J., McManus, F., Brady, F., Salkovskis, P., & Clark, D. M. (2013). Implementation of cognitive therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample. Behaviour Research and Therapy, 51(11), 742–752. DOI: 10.1016/j.brat.2013.08.006
Ehlers, A., Hackmann, A., Grey, N., Wild, J., Liness, S., Albert, I., Deale, A., Stott, R., & Clark, D. M. (2014). A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy. American Journal of Psychiatry, 171(3), 294–304. DOI: 10.1176/appi.ajp.2013.13040552
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for PTSD: Development and evaluation. Behaviour Research and Therapy, 43, 413-431. DOI: 10.1016/j.brat.2004.03.006
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., & Herbert, C. M. R. (2003). A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessment as early interventions for PTSD. Archives of General Psychiatry, 60, 1024-1032. DOI: 10.1001/archpsyc.60.10.1024
Gillespie, K., Duffy, M., Hackmann, A., & Clark, D. M. (2002). Community based cognitive therapy in the treatment of post-traumatic stress disorder following the Omagh bomb. Behaviour Research and Therapy, 40, 345-357. DOI: 10.1016/S0005-7967(02)00004-9
Meiser-Stedman, R., Smith, P., McKinnon, A., Dixon, C., Trickey, D., Ehlers, A., Clark, D.M., Boyle, A., Goodyer, I., Dalgleish, T. (2016). Cognitive therapy versus wait list as an early intervention for PTSD in children and adolescents: A randomized controlled trial. Journal of Child Psychology and Psychiatry, DOI:10.1111/jcpp.12673
NICE (National Institute for Health and Care Excellence). (2018). Posttraumatic stress disorder. NICE guideline 116. https://www.nice.org.uk/guidance/ng116/resources
Smith, P., Yule, W., Perrin, S., Tranah, T., Dalgleish, T., & Clark, D.M. (2007). Cognitive-behavioral therapy for PTSD in children and adolescents: A preliminary randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1051-61. DOI: 10.1097/CHI.0b013e318067e288

Eni Becker

Workshop Six

Exposure therapy for Generalized Anxiety Disorder
Eni S. Becker, Behavioural Science Institute, Radboud University, Nij-Ca2re, Nijmegen Centre for Anxiety and Affective Disorders Research and Expertise

This workshop focuses on the use of in-sensu and in-vivo exposure in the treatment of Generalized Anxiety Disorder. At the centre of the intervention are the excessive worries patients with GAD suffer from. Worrying seems to be a special way of experiential avoidance. Patients with GAD suffer from a strong intolerance of intense emotions,  eliciting the worry process to down regulate them. Worry exposure is targeting those feared emotions. In this workshop, background will be given on GAD and its diagnosis, as well as a more in-depth look at the worry process. Furthermore, details will be given on how patients can be motivated to participate in exposure treatment, and how the exposure is conducted. Exposure in-vivo is accompanying in-sensu exposure interventions in GAD.  Here some options will be demonstrated to target the worries directly, in addition to overcoming safety behaviours. Possible exercises will be discussed and exposure plans will be designed. Exposure treatment can be a very effective way to treat GAD, if the specific characteristics of GAD are taken into account.

Many patients suffer from GAD, actually considerably more than from Panic disorder. But these patients are often overlooked, or their GAD is overlooked, because this disorder is also very co-morbid. But worrying is a crippling symptom, and negative repetitive thinking styles are closely linked to reduced treatment success or higher changes to relapse. Thus, GAD should be targeted. This workshop will give the tools necessary to tackle worries more directly, and thus hopefully help the patients.

Key learning objectives:

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

  • diagnosis of GAD
  • understanding of the worry process
  • how to motivate the patient for exposure in vivo
  • How to do worry exposure in sensu
  • How to do exposure in vivo

Prof Eni S. Becker is the chair of Clinical Psychology (since 2003) and the director of the research program ” Experimental psychopathology and treatment” of the Behavioural Science Institute at the Radboud University Nijmegen. She is also chair of Nij-CARE (Nijmegen Centre of Anxiety and Affective Disorder research and Expertise). She studied at the Philipps-University of Marburg, Germany, getting her PhD in 1996. She was Visiting scholar at the Dept. of Psychiatry and Behavioural Sciences, Stanford University. (1991-19992), and then Assistant Professor (1996-2003) and Juniorprofessor (2003-2004) at the Institute of Clinical Psycho­logy, Technical University of Dresden. Prof Becker is trained as a behaviour therapist at the Dresden Academy of Psychotherapy (DAP) (1996-2000)and is a GZ-psycholoog and psychotherapist in the Netherlands. Since 1996 she is regularly giving courses for therapist in behaviour therapy on treatment of Anxiety Disorders. Her research interests are cognitive processes in anxiety and depression,  as well as cognitive bias modification, approach and avoidance behaviour, and Behaviour therapy for generalized anxiety disorder.

Key references

Hoyer, J., Beesdo, K., Gloster, A. T., Runge, J., Höfler, M., & Becker, E. S. (2009). Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder. Psychotherapy and Psychosomatics, 78(2), 106-115.
Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., Van Ameringen, M., Smits, J. A. J., & Powers, M. B. (2020). Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy49(1), 1-21. DOI: 10.1080/16506073.2018.1560358
Newman, M. G., & Llera, S. J. (2011). A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry. Clinical psychology review31(3), 371-382.

Workshop Seven

Towards an understanding of distress in the face of real-life uncertainty and threat: A trans-situational approach.
Mark Freeston, Newcastle University, UK

Over the last few years we have developed a single-strand transdiagnostic treatment for anxiety and similar disorders targeting intolerance of uncertainty and started to test it in both individual and group formats. In 2019 we started to develop a trans-situational model while thinking about life situations such as carers of people with dementia, or people with potentially life-threatening illnesses and their carers, where the threat and uncertainty may be very real and distress is understandable.  However, the question is how we translate an understanding of anxiety and distress grounded in mental health problems to these situations. Anxiety disorders are by definition characterized by disproportionate reactions to potential threats and are generally based on misinterpretations of the dangerousness of the object or situation, whether in phobias, GAD or panic. Some of our knowledge from the study and treatment of anxiety disorders can be applied to situations where there is real threat or danger.  However, in these situations, the perceptions of threat may have a greater degree of accuracy or at least it may be more difficult to identify what is accurate or not.  Accurate perception of threat may be more difficult when there is a high degree of actual uncertainty in the situation.  We propose that uncertainty and threat jointly contribute to distress.  The degree of uncertainty may be further increased by the way information is provided, accessed, and understood.  The greater the perceived uncertainty, the more people tend to consider and act on the more severe end of the range of possible threats.    Thus, uncertainty will contribute to distress both directly, as uncertainty is uncomfortable and often very upsetting, and indirectly through its effect on perception of threat. Further, as in models of anxiety, cognitive and behavioural strategies aimed at reducing threat and/or uncertainty may further increase the perceptions of both.  Conspiracy beliefs may be understood, at least in part, as strategies to manage uncertainty. Finally, and linking back to almost three decades of work on intolerance of uncertainty, people’s dispositional tolerance of uncertainty will also contribute, especially when heightened under conditions of life disruption.

The pandemic has provided ample opportunities for us to gain further understanding of the role of uncertainty and threat. However, to illustrate the trans-situational nature of the model, I will present data from caregivers of people with dementia, Covid-19 in the earlier stages of the pandemic, those experiencing long Covid, and climate change. I will also consider some of the implications of the model for interventions, including treatment, but also for prevention. These will include not only the management of uncertainty distress in the present and near future, but also future thinking and the pursuit of goals in the face of ongoing uncertainties.

Professor Mark Freeston is Professor of Clinical Psychology at the University of Newcastle. The basis of his work has been the understanding and treatment of anxiety disorders His particular interests are Obsessive Compulsive Disorder and Generalised Anxiety Disorder. Interestingly, his work has led to multi-dimensional models and multi-component treatment packages. With the emergence of transdiagnostic approaches and models, there is a natural extension of this work to separation anxiety disorder, psychosis, eating disorders, body-focused repetitive behaviours, and body-dysmorphic disorder. One such transdiagnostic process is Intolerance of Uncertainty (IU), a construct he was first working with in the early 1990s at Université Laval in Quebec.

Workshop Eight

Moving Beyond Therapy Manuals: An Introduction to Process-Based CBT.
Stefan G. Hofmann, Ph.D., Department of Psychological and Brain Sciences,Boston University, USA

Process-Based CBT (PCBT) is a radical departure from the latent disease model of the DSM and the absurd proliferation of the protocols-for-syndrome approach. Instead, PBCBT focuses on how to best target and change core biopsychosocial processes in a specific situation for given goals with a given client. This approach recognizes that psychotherapy typically involves non-linear (rather than linear), bidirectional (rather than unidirectional), and dynamic changes of many (rather than only a few) interconnected variables. Effective therapy changes the entire system toward a stable and adaptive state. For therapy to be most effective, we, therefore, need to embrace a systematic, assessment-guided, and theory-based approach to understand the relationships of the various problems of a given client. Functional analysis, the foundation of behavior therapy, provides the basis to understand these relationships. PBCBT acknowledges the complexity, inter-relatedness, and multidimensional levels of the problems in a given client. This workshop will illustrate how PBCBT is used to target key treatment processes by combining functional analysis with a dynamic and person-specific network approach. The workshop will discuss specific strategies to target specific processes in a specific client.

Maximize treatment efficacy by tailoring CBT strategies to the individual client using complex network approaches and principles grounded in evolutionary science.

Key learning objectives:

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

  • Appreciating the limitations and weaknesses of the contemporary medical model.
  • Gaining an up-to-date understanding of the core processes of CBT.
  • Developing an idiographic, functional diagnostic system that has treatment utility.
  • Establishing more progressive models and theories in clinical practice.
  • Using functional analysis in conjunction with complex network approach in a given client

Stefan G. Hofmann, Ph.D. is professor of psychology at the Department of Psychological and Brain Sciences at Boston University and Humboldt Professor at the University of Marburg, Germany. He has an actively funded research program studying various aspects of emotional disorders with a particular emphasis on anxiety disorders and cognitive behavioral therapy. He has won many prestigious professional awards, including the Aaron T. Beck Award for Significant and Enduring Contributions to the Field of Cognitive Therapy by the Academy of Cognitive Therapy and the Alexander von Humboldt Research Award. He is a fellow of the APA and APS and was president of various national and international professional societies, including the Association for Behavioral and Cognitive Therapies and the International Association for Cognitive Psychotherapy.  He was also an advisor to the DSM-5 Development Process and a member of the DSM-5 Anxiety Disorder Sub-Work Group. Dr. Hofmann has been identified as a Highly Cited Researcher by Thomson Reuters. He is currently editor of Cognitive Therapy and Research and associate editor of Clinical Psychological Science. He has published more than 350 peer-reviewed journal articles and 20 books, For more information, visit http://www.bostonanxiety.org/

Key references

Hayes, S. C. & Hofmann, S. G. (2017). The third wave of CBT and the rise of process-based care. World Psychiatry, 16, 245-246. doi: 10.102/wps.20442
Hayes, S. C. & Hofmann, S. G. (Eds.) (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. Oakland, CA: New Harbinger Publications. ISBN-13: 978-1626255968.
Hofmann, S. G., & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science, 7, 37–50. doi: 10.1177/2167702618772296
Hofmann, S. G., Curtiss, J. E., & Hayes, S. C. (in press). Beyond linear mediation: Toward a dynamic network approach to study treatment processes. Clinical Psychology Review. doi: 10.1016/j.cpr.2020.101824

Lars Goran Ost

Workshop Nine

One-session treatment of specific phobias
Lars-Göran Öst Professor emeritus of clinical psychology, Dept of Psychology, Stockholm University

Specific phobia is the most prevalent of all psychiatric disorders in the general population with a lifetime prevalence of 12.5%. However, few people suffering from specific phobia apply for treatment, mainly because they are not aware of the treatment possibilities, or they are afraid that the treatment itself will be worse than having the phobia. I have developed a rapid treatment that is carried out in one single session, which is maximised to 3 hours. The treatment is based on a cognitive behavior analysis of the catastrophic beliefs the patient has in relation to a possible confrontation with the phobic object or situation. Exposure in-vivo is done as a series of behavioral experiments to help the patient test the catastrophic beliefs they have. In animal phobics participant modelling is used as an adjunct. During the last two decades I have done 11 randomized clinical studies on phobias of spiders, snakes, blood-injury, injections, dental care, flying and enclosed places in adults and 2 studies on various specific phobias in children and adolescents. The mean treatment time varies between 2 and 3 hours and the proportion of clinically significant improvement between 78-93%. The effects are maintained, or furthered, at the 1-year follow-up. These results have been replicated in at least 28 RCTs carried out in USA (8), Germany (4), Holland (4), Australia (3), Austria (2), England (2), Norway (2), Belgium (1), Canada (1), and Spain (1).

Knowing how specific phobias can be treated in a one-session format will give clinicians an additional tool for their clinical work load.

Key learning objectives:

During the workshop the participants will learn to assess specific phobias and get video and live demonstrations of how these can be treated in a one-session format using exposure and modelling.

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

Have a thorough knowledge how one-session treatment for specific phobias is carried out and hopefully be able to try it in their own clinical work

Lars-Göran Öst is Professor emeritus of Clinical Psychology at Stockholm University and senior researcher at the Haukeland University Hospital, Bergen, Norway. He qualified as a clinical psychologist in 1971, got his Ph.D. in 1976 and Dr of Medical Science in 1985. He was one of the founders of the Swedish Association of Behavior Therapy as well as the European Association of Behavior Therapy, both in 1971. He took the initiative to the World Congress Committee in 1993 and served as its first president 1995-1998. Professor Öst is well-known for his development and research on three methods for the treatment of anxiety disorders: one-session treatment in specific phobias, applied relaxation in GAD and panic disorder, and applied tension in blood-injury phobia. He has published six books and over 300 articles and book chapters.

Key references

Davis III, T., Ollendick, T. & Öst, L-G. (Eds.) (2012). Intensive one-session treatment of specific phobias. New York: Springer.

Öst, L-G. (1989). One-session treatment for specific phobias. Behaviour Research & Therapy, 27, 1-7.
Öst, L-G., Alm, T., Brandberg, M. & Breitholtz, E. (2001). One vs. five sessions of exposure and five sessions of cognitive therapy in the treatment of claustrophobia. Behaviour Research and Therapy, 39, 167-183.
Öst, L-G., Svensson, L., Hellström, K., & Lindwall, R. (2001). One-session treatment of specific phobias in youth: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 69, 814-824.