BABCP 2012 Spring Conference and Workshops

BABCP Spring Workshops and Conference

Trauma across the Lifespan Thursday 12 - Friday 13 April 2012 King’s College London Keynotes Reg Nixon, Flinders University, Australia Chris Brewin, University College London, UK Bernice Andrews, Royal Holloway, University of London, UK Emily Holmes, University of Oxford, UK

Workshops Reg Nixon, Flinders University, Australia How to Bounce Back When the Going Gets Tough: Treating Comorbid PTSD and Depression in Adults Patrick Smith, Institute of Psychiatry, King’s College London, UK New Advances in Treating Child and Adolescent Trauma Nick Grey, Institute of Psychiatry, King’s College London, UK Memory-focused Techniques in Cognitive Therapy for PTSD in Adults Antje Horsch, University of Lausanne, Switzerland, and Ann Hackmann, Oxford Cognitive Therapy Centre, UK Treating PTSD in the Perinatal Period with Imagery and CBT Deborah Lee, University College London and Berkshire Traumatic Stress Service, UK Compassion-focused CBT for Adults with PTSD and Childhood Trauma Imogen Sturgeon-Clegg, Combat Stress, UK and Ken Laidlaw, University of Edinburgh, UK Using the past to get to a better future: CBT for Trauma in Older Age

For further information, including programme updates and details of how to register, please visit www.babcpconference.com

Workshop Programme Thursday 14th April 2011 WORKSHOP 1 How to bounce back when the going gets tough: Treating comorbid PTSD and depression in adults Reg Nixon, School of Psychology, Flinders University, Australia Clinicians rarely have the luxury of treating PTSD in the absence of other comorbidity. Depression is one of the most common comorbid disorders to accompany PTSD. Features of depression such as entrenched maladaptive core beliefs and numbing can interfere with the known mechanisms through which PTSD is successfully treated with CBT (e.g., reducing rigid trauma-related beliefs, amelioration of strong negative affect associated with trauma memories etc).

There are a myriad of different CBT methods that are effective for PTSD and depression (e.g., cognitive therapy, behavioural activation, imaginal or written exposure, in vivo exposure). This workshop will focus on when and how to most effectively use these skills in clients with PTSD and comorbid depression. Issues of treatment sequencing, clinical challenges associated with trauma-focused work and how to adapt evidence-based protocols for routine clinical practice will be addressed.

Learning objectives: 1.

To increase understanding of how PTSD and depression can reciprocally influence therapy outcome.

2. To develop confidence in synthesising varying treatment methods to address both PTSD and depression.

3. To understand how to flexibly apply CBT methods in the treatment of comorbid PTSD and depression without diluting its effectiveness.

Implications for the science and practice of CBT: Workshop participants should become more confident in conceptualising how to best treat comorbid PTSD and depression. Participants will also acquire practical resources and materials to better assist their clients.

Reg Nixon is a registered clinical psychologist and academic who has been involved in the research and treatment of child and adult PTSD for the past 14 years. He has worked with a range of client groups, including single-incident trauma as well as child and adult survivors of physical and sexual assault, domestic violence, and combatrelated trauma. His clinical work in PTSD has been in the context of research trials examining the efficacy of components of CBT as well as the use and dissemination of trauma-focused therapy into routine clinical practice. He is an accredited trainer in Cognitive Processing Therapy, and is accredited by the Psychology Board of Australia (the national registration board) as a clinical psychology supervisor.

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Martel, C.R., Dimidjian, S., & Herman-Dunn, R. (2010). Behavioral activation for depression: A clinician’s guide. New York, NY: Guildford Press.

Nixon, R.D.V. & Nearmy, D.M. (2011). Treatment of Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder: A Pilot Study. Journal of Traumatic Stress, 24, 451–455.

Resick, P.A., Monson, C.M., & Rizvi, S.L. (2008). Posttraumatic Stress Disorder. In Barlow, D.H. (2008). th Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual (4 ed.) (pgs. 65-122).

New York: Guilford Press.

WORKSHOP 2 New advances in treating child and adolescent trauma Patrick Smith, King’s College London & South London and Maudsley NHS Foundation Trust Cognitive models of PTSD were developed initially to explain adults’ reactions to traumatic events. More recently, models have been adapted for children and adolescents, tested in at risk (i.e. trauma-exposed) young people, and used to inform developmentally-appropriate Trauma-Focused CBT treatment protocols.

This workshop will describe how Ehlers and Clark’s (2000) cognitive model of PTSD and treatment protocol has been adapted for use with young people. Recent evidence regarding children’s appraisals, the nature of trauma memories, and family functioning in the aftermath of trauma will be reviewed. The workshop will cover: how to carry out assessment and derive an idiosyncratic cognitive formulation; and how to implement key treatment components of TF-CBT with young people, including imaginal reliving, updating traumatic memories, working with triggers, and working with families. The emphasis will be on individual, formulation-driven TF-CBT. Protocols for working with very young preschool children will also be demonstrated.

Learning objectives: 1. Up to date knowledge of the applicability of cognitive models of PTSD to children and young people.

2. How to carry out assessment and formulation with young people and families.

3. How to plan and deliver individually tailored TF-CBT with children and families.

Implications for the science and practice of CBT: Participants will be able to deliver effective, evidence-based treatment for young people with PTSD. Patrick Smith is a lecturer in psychology at the Institute of Psychiatry King’s College London, and Honorary Consultant Clinical Psychologist at the South London and Maudsley NHS Foundation Trust. He works in a long-established Child Traumatic Stress Clinic, and is co-founder of a specialist Mood Disorder Clinic for young people.

On completing his clinical training, he led a UNICEF-funded psychosocial programme for war-affected children in Bosnia. His collaborative research since then has focused on understanding children’s psychological reactions to trauma, and on developing interventions for traumatised young people. With colleagues, he has investigated cognitive models of PTSD in children; evaluated individual TraumaFocused CBT for children and young people in a randomized controlled trial; and has helped to develop and evaluate group interventions for children exposed to war and disasters.

Ehlers, A. & Clark, D.M. (2000). A cognitive model of post-traumatic stress disorder. Behaviour Research & Therapy, 38, 319-345.

Smith, P., Yule, W., Perrin, S, Tranah, T., Dalgleish, T., & Clark D.M. (2007). Cognitive behavioural therapy for children and adolescents – a preliminary randomised controlled trial. Journal of the American Association for Child and Adolescent Psychiatry, 46, 1051-1061 Smith, P., Perrin, S., Yule, W., & Clark, D.M. (2010). Cognitive therapy for post traumatic stress disorder. Routledge Press, London

WORKSHOP 3 Memory-focused approaches in Cognitive Therapy for adults with PTSD Nick Grey, Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust Guidelines from around the world for the treatment of PTSD in adults recommend trauma-focused CBT as a first line treatment. In essence ‘trauma-focused’ means placing an emphasis on discussing the details of the traumatic memories. This can be emotionally demanding for both patient and therapist. Despite the treatment guidelines many therapists still do not use ‘trauma-focused’, i.e. memory-focused, approaches.

This workshop demonstrates the range of memory-focused approaches used in Cognitive Therapy for PTSD, the treatment based on Ehlers and Clark’s (2000) cognitive model for PTSD. These memory-focused techniques include reliving/exposure, written narratives, stimulus discrimination, and site visits. The obstacles that both patients and therapists present to using these highly effective techniques will be addressed. The timing of such techniques within an overall treatment programme will be discussed.

Learning objectives: 1. To be aware of the range of memory-focused techniques including reliving/exposure, written narratives, stimulus discrimination, and site visits.

2. How to choose which approach to adopt at which time.

3. How to integrate memory-focused approaches in a course of treatment.

Implications for the science and practice of CBT: Participants should be more confident in trying to use memory focused techniques in treatment of adults with PTSD. Patients will receive the treatment approaches with the best evidence for their effectiveness.

Nick Grey is a Consultant Clinical Psychologist at, and Joint Clinical Director of, the Centre for Anxiety Disorders and Trauma (CADAT), South London & Maudsley NHS Foundation Trust, and Institute of Psychiatry, King’s College London. His clinical work is providing outpatient cognitive therapy to people with a variety of anxiety disorders and PTSD, both within randomized controlled trials and in a more general NHS service. CADAT forms part of three local IAPT services and also offers a national service (www.national.slam.nhs.uk/cadat). He is a BABCP accredited practitioner, supervisor and trainer.

Ehlers, A. & Clark, D.M. (2000). A cognitive model of post-traumatic stress disorder. Behaviour Research & Therapy, 38, 319-345.

Ehlers, A., Clark, D.M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for posttraumatic stress disorder: development and evaluation. Behaviour Research and Therapy, 43, 413431.

Grey, N. (Ed.) (2009). A casebook of cognitive therapy for traumatic stress reactions. Hove: Routledge.

WORKSHOP 4 Treating PTSD in the perinatal period with trauma-focused CBT and imagery techniques.

Antje Horsch, University of Lausanne, Switzerland and Ann Hackmann, Oxford Cognitive Therapy Centre, UK This workshop will draw on cognitive models to conceptualise PTSD in the perinatal period, i.e. during pregnancy and up to one year after childbirth, including perinatal loss (miscarriage, stillbirth, neonatal death). The focus of this skills-based workshop will be on developing specialist skills in assessment, formulation and trauma-focused cognitive-behavioural therapy (based on Ehlers and Clarks, 2000) for this population with a particular focus on imagery re-scripting techniques. Theories explaining the role of mental imagery in PTSD symptomatology will be presented and clinical applications of these in the treatment of women (and their partners) during the perinatal period will be discussed.

Learning objectives: 1. Participants will learn about cognitive models of PTSD and theoretical models explaining the role of mental imagery in the perinatal population.

2. Participants will develop specialist evidence-based skills in assessment, formulation and trauma-focused cognitive-behavioural therapy for PTSD in the perinatal period, with a particular focus on imagery re-scripting techniques.

Implications for the science and practice of CBT: Participants should be able to apply evidence-based trauma-focused CBT techniques and imagery-rescripting techniques in their clinical work with women (and their partners) in the perinatal period.

Antje Horsch is a clinical psychologist who is now based at the University of Lausanne. Prior this, she worked in the Berkshire Traumatic Stress Service (Reading) where she ran a specialist clinic for women who had posttraumatic stress disorder (PTSD) following childbirth and perinatal loss, and at the Institute for Clinical Psychology Training (University of Oxford) where she conducted and supervised research in the area of PTSD and traumatic grief in the perinatal period and cofounded the Oxford Perinatal Psychology Research Group (OPAL).

Ann Hackmann is a clinical psychologist who is an associate of the Oxford Cognitive Therapy Centre, and the Oxford Mindfulness Centre at the University of Oxford. For many years she worked in a research group refining cognitive therapy protocols for anxiety disorders. She was a therapist in several trials of cognitive therapy for PTSD. Her special interest is in imagery, and with James Bennett-Levy and Emily Holmes she has published the Oxford Guide to Imagery in Cognitive therapy (2011). She also worked as the clinical supervisor on a trial of imagery rescripting in the treatment of depression.

Horsch, A. (2009). Post-traumatic stress disorder following childbirth and pregnancy loss. In H. Beinart, P. Kennedy & S. Llweleyn (Eds.), Clinical Psychology in Practice. Oxford: Blackwell Publishing Ltd. Ayers, S. (2004). Delivery as a traumatic event: Prevalence, risk factors, and treatment for postnatal posttraumatic stress disorder. Clinical Obstetrics and Gynecology, 47, 552-567.

Ayers, S., McKenzie-McHarg, K. & Eagle, A. (2007). Cognitive behaviour therapy for postnatal posttraumatic stress disorder: case studies. J of Psychosomatic Obsterics & Gynecology, 28, 177-184.

Hackmann, A., Bennett-Levy, J., and Holmes, E.A. (2011) Oxford Guide to Imagery in Cognitive Therapy. Oxford University Press: Oxford.

Holmes, E. M. & Hackmann, A., (ed.) (2004). Imagery in Psychopathology and its Relationship to Memory. Special Issue of Memory.

WORKSHOP 5 Compassion-focused CBT for Adults with PTSD to Childhood Trauma Deborah Lee, Berkshire Traumatic Stress Service & University College London This workshop explore compassionate focused therapeutic ways of working with people who have experienced childhood trauma that have left them feeling ashamed and very self- attacking.

Although we can consider shame as in part, a threat based response, the fear is very much focused on how we perceive we live in the mind of others and the fear of how we live in our own minds. Such fears do not necessarily respond well to exposure based clinical interventions and sometimes shame can intensify and exacerbate with exposure. This seems especially true for those who struggle to self sooth and access emotional memories of being soothed, cared for and feeling safe in the mind of others.

Compassion focused therapy focuses on the development of these emotional experiences and offers a theoretical, clinical and evidence based way to work with distressing shame and self attack. It is based on social mentality theory (Gilbert, 2005) and draws on neuroscience, attachment theory and evolution to explore nature of shame-based, negative self-evaluations.

The clinical conundrum is whether we can enhance our evidence based practice such as trauma focused CBT or EMDR with new clinical directions such as compassion focused therapy. A combined approach could offer exciting new ways of working with shame based trauma experiences and shame based PTSD. So this workshop will bring together two schools of thought to enhance our clinical practice with shame based trauma: trauma focused CBT and compassion focussed therapy The workshop will present a phased based approach to treatment and theorypractice links on how to develop a compassionate mind in order access feelings of self soothing and safeness. The chapter will explore ways to develop inner compassion via imagery and the generation of compassionate feelings for the self..

The workshop will then explore how to weave compassionate feelings, images and compassionate ways of thinking into more traditional ways of working with childhood trauma such as developing a narrative, imaginal and in vivo exposure to traumatic events and, enhanced reliving. Case material will be used to illustrate these integrated techniques and consideration will be given to challenges and blocks that might arise in the course of therapy.

Learning objectives: 1. To be aware of the range of memory-focused techniques including reliving/exposure, written narratives, stimulus discrimination, and site visits.

2. How to choose which approach to adopt at which time.

3. How to integrate memory-focused approaches in a course of treatment.

Implications for the science and practice of CBT: Participants should be more confident in trying to use memory focused techniques in treatment of adults with PTSD. Patients will receive the treatment approaches with the best evidence for their effectiveness.

Dr Deborah Lee is a Consultant Clinical Psychologist and Head of the Berkshire Traumatic Stress Service. She is honorary Senior Lecturer in Clinical Psychology at University College London. Dr Lee has worked in the field of adult trauma, as a specialist for 20 years. Her clinical interests lie in the working with adult survivors of

PTSD, complex trauma and shame based memories relating to trauma experiences.

Her research interests include shame and self- criticism in PTSD and the use of compassionate imagery to work with shame-based flashbacks in child and adult trauma. She has recently developed a group based intervention using compassion approaches to treat PTSD. She has provided teaching and training in the field of traumatic stress in the U.K., Europe and North America. She has published in academic and clinical journals and has written over 30 articles, book chapters and papers on her clinical work and research. She has recently finished a self help book on the compassionate mind guide to recovering from shame and trauma.

Gilbert, P (2009). The Compassionate Mind, Constable and Robinson, London Lee, D.A (2009). Lee, D.A (2009). Compassion Focused Cognitive Therapy For Shame-based Trauma Memories and Flashbacks in PTSD. In Grey, N. (Eds.) A Casebook of Cognitive Therapy for Traumatic Stress Reactions. Chapter 15. London: Brunner-Routledge.

Lee, D,A., (2012) The Compassionate Mind Approach to Recovering from Trauma and Shame. New Harbinger Press.

Lee, D.A. (2005) The perfect Nurturer: Using imagery to develop compassion within the context of cognitive therapy. In Gilbert (Ed.) Compassion: Conceptualisations, Research and Use in Psychotherapy. London Brunner-Routledge.

WORKSHOP 6 Using the past to get to a better future: CBT for trauma in old age Imogen Sturgeon-Clegg, Combat Stress & Ken Laidlaw, University of Edinburgh/NHS Lothian.

The population aging we are witnessing today is unprecedented in the whole of human history (UN, 2010). Psychotherapists are now much more likely to come into contact with older people and yet may feel ill-prepared to meet the needs of this new cohort of older people (Laidlaw & Pachana, 2009, 2011). Much less emphasis has been placed on understanding process issues in CBT with older people and understanding an age appropriate lifespan developmental approach to conceptualisation of CBT with older people. Theories from Gerontology such as wisdom can be useful vehicles for change with older people and can point a way to achieving a reduction in negative affect and an increase in positive affect. This new approach to be CBT with older people is outlined here.

CBT is particularly appropriate as an intervention for older people as it is skills enhancing, present-oriented, problem-focussed, straightforward to use and effective.

While depression in later life is often misunderstood as a ‘natural’ consequence of challenges and losses faced by older people, this unhelpful belief in therapists negates efficacious therapeutic outcomes as therapy becomes unfocussed, passive and less effective. This is one of several misperceptions about working therapeutically with older adults. It is therefore important for psychotherapists to address his or her attitudes and misperceptions about aging and the current and future generations of older people and the effect it may have on working with this client group.

The effects of having experienced a past traumatic event can last for many years or can emerge after lying dormant for many years after the trauma, triggered perhaps by a life event such as retirement, ill health or bereavement. Of course traumatic events can also occur in later life (Hunt, 1997).

There are some traumatic experiences that are specific to the current generation of older adults due to the social, political and historical context in which they grew up (those experienced as a result of the Second World War, for example) and some that

are universal to human beings of all ages. However, differing generational attitudes and experiences (such as those relating to education and child abuse, for example) will influence an older person’s perception of a traumatic experience. These attitudes may also influence an older person’s willingness and ability to engage in cognitivebehavioural therapy (Hunt, 1997; Sturgeon-Clegg, in press). It is essential that these differences are understood and woven into CBT interventions, the framework recommended in the NICE guidelines.

Learning objectives: 1. Have an understanding of trauma in later life and how it may present differently 2. Understand the difference between conceptual and procedural modifications to enhance outcome in CBT with older people 3. Feel confident in applying CBT techniques with older adults

Implications for the science and practice of CBT: Greater confidence and skills in working with older adults who have suffered a traumatic experience using a CBT framework adapted to suit the current and future generations of older people.

Dr. Imogen Sturgeon-Clegg is an experienced practitioner in CBT with older adults.

Before working for the charity Combat Stress, she worked for Older Adult Mental Health Services which were part of the then NHS North East London Mental Health Trust for nine years. During this time she was awarded a grant from their Research and Development Department to carry out research which culminated in a project entitled ‘Long-term Effects of Experiencing Evacuation and the Bombing of London during the Second World War: a qualitative study’ as well as two papers, one a critical literature review of the psychological interventions suggested for veterans of the Second World War and the other a client study addressing avoidance in veterans with post-traumatic stress disorder. She currently works for Combat Stress and has been involved in developing and delivering a new six week treatment programme for ex-servicemen and women suffering from PTSD. As a Visiting Lecturer she has contributed to the MSc in Aging and Mental Health at UCL, teaching about psychological interventions for older adults suffering traumatic experiences, depression, anxiety and challenging behaviour, and CBT element of the Counselling Psychology programme at City University. She has presented her research at past PSIGE and BABCP conferences.

Dr Ken Laidlaw is an experienced practitioner and researcher in CBT with older people. He is a part-time Senior Lecturer at Edinburgh University and Consultant Clinical Psychologist within NHS Lothian as clinical lead for the older adults clinical psychology services in Edinburgh. In 2000-2001 he was a research fellow and visiting scholar with Professor A.T. Beck at the University of Philadelphia, USA and he has maintained a long and productive collaboration with CBT Older adult pioneers, Professors Larry W. Thompson and Dolores Gallagher-Thompson at Stanford University, California, USA. Ken has published empirical research in peerreviewed international journals, and carried out the first UK randomized controlled trial of individualised CBT for late life depression. He also developed a new cross cultural measure of attitudes to ageing. Ken has also authored a number of book chapters looking at CBT with older people. Recently Ken has started to look at how to augment CBT with older by using gerontological theory and was invited to revise a paper (Laidlaw & Pachana, 2009) for the APA Monitor special feature, The CE Corner, designed to bring recent advances in the science and practice of psychology to the Association’s membership. He has published three books and is working on an new introductory textbook on CBT with older people as well as the second edition of CBT with older people with Larry Thompson and Dolores Gallagher-Thompson.

Laidlaw, K. & Knight, B.G (Eds.,). (2008) Handbook of the Assessment and Treatment of Emotional Disorders in Late Life: A Guide to Concepts and Practice. Oxford: Oxford University Press. ISBN 978-019-856945-9 Laidlaw, K., Thompson, L.W., Siskin-Dick, L., & Gallagher-Thompson, D. (2003) Cognitive Behavioural Therapy with Older People. Chichester: John Wiley & Sons, Ltd. ISBN 978-0-47111-1 Hunt, L. (Ed) (1997) Past Trauma in Late Life: European Perspectives on Therapeutic Work with Older People. London: Jessica Kingsley Publishers. ISBN-13:978-1853024467

BABCP Spring Conference Friday 13th April 2012 Kings College, London (Waterloo Campus)

Trauma across the Lifespan Keynote Speakers Professor Reg Nixon, Finders University, Australia CBT for PTSD: Where to from here?

Professor Chris Brewin, University College London Recent Insights into the Nature of Memory Dysfunction in Posttraumatic Stress Disorder Professor Bernice Andrews, Royal Holloway, University of London Shame, Trauma and Disorder Professor Emily Holmes, University of Oxford Flashbacks: From an Experimental Psychopathology Perspective

Symposium Speakers Symposium: New advances in preventing PTSD Ella James, University of Oxford Preventative treatment interventions for intrusive trauma memories: From memory consolidation to reconsolidation.

Rachel White, Institute of Psychiatry, King's College London & Jennifer Wild, Experimental Psychology, University of Oxford Why or How? Preventing the development of intrusions after exposure to trauma Jennifer Wild, Experimental Psychology, University of Oxford Prevention begins with assessment: Self-report vs. clinical interview for PTSD in atrisk populations and screen and treat programmes

BABCP Spring Conference and Workshops Registration Form 12th/13th April 2012 • King’s College London

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1: Treating Comorbid PTSD and Depression in Adults : Reg Nixon

2: New Advances in Treating Child and Adolescent Traum: Patrick Smith

3: Memory-focused Techniques in Cognitive Therapy for PTSD in Adults: Nick Grey

4:Treating PTSD in the Perinatal Period with Imagery and CBT: Antje Horsch and Ann Hackmann 5: Compassion-focused CBT for Adults with PTSD and Childhood Trauma : Deborah Lee 6: CBT for Trauma in Older Age: Imogen Sturgeon-Clegg and Ken Laidlaw

Spring Conference: BABCP Member £80, Non-member £110, BABCP Student Member £60 Spring Workshops: BABCP Member £125, Non-member £160, BABCP Student Member £80 Both booked together: BABCP Member £190, Non-member £245, BABCP Student Member £135 Payment:

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