EXAMPLE OF A CLINICAL SYMPOSIUM
Body image in Eating Disorders: Assessment and Treatment
Convenor: Tuschen-Caffier, B University of Bielefeld, Germany
Dissatisfaction with body weight and shape is typical for patients with eating disorders. However, it is still unknown, how patients with eating disorders experience their body in their everyday life and what kind of treatment may enhance body dissatisfaction. Especially, it is unknown, what kind of beliefs may maintain body checking behavior or the avoidance of self-exposure to mirrors. Furthermore, it is an open question whether body dissatisfaction requires a specific intervention and which techniques may be most effective in the treatment of body dissatisfaction. Therefore, the symposium will focus on the following themes: The first presentation (Mountford) will be about the relationship between body checking behaviors and related beliefs in eating-disordered as well as healthy women. Data on psychometric characteristics based on a new measure of cognitions regarding body checking behaviours (using an established measure) will be analysed. The second presenter (Probst) will talk about the mirror behaviour of patients with eating disorders. Furthermore, the presentation will give an insight into the body experience of patients who do and those who do not avoid mirrors. Concerning the treatment of dissatisfaction with body shape and weight exposure techniques have recently been included in treatment programs. However, previous research cannot answer the question if body exposure is more efficient than other interventions. Thus, the following two presentations are addressed to this research theme: One presentation ( Wilson) will be about guided mirror exposure with a mindfulness-based rationale compared to a credible, nondirective treatment intervention. The other presentation (Tuschen-Caffier) will be about mirror exposure compared to cognitive interventions and a waiting-list condition. The primary aim of the last talk (Shafran) is to determine the influence of body size estimation on the immediate and longer-term outcome of patients with eating disorders treated with cognitive-behavioural therapy.
Mountford, V and Haase, A. St George’s Eating Disorder Service, University of Bristol, UK
Probst, M. K.U. Leuven, Department Rehabilitation Sciences and Universitair Centrum Kortenberg, and Arteveldehogeschool Opleidingseenheid Kinesitherapie Gent, Belgium.
Wilson , T, Rutgers University, USA
Tuschen-Caffier, B, Schüssel, C. Department of Psychology, University of Bielefeld, Germany, and Weinbrenner, B. Christop-Dornier-Stifung Für Klinische Psychologie, Institut Siegen, Germany
EXAMPLE OF A RESEARCH SYMPOSIUM
Recent developments in Social Phobia
Convenors: Heidenreich, T., Clinic of Psychiatry and Psychotherapy II; University Clinic Johann Wolfgang Goethe and Stangier, U, Department of Psychology; University of Frankfurt, Germany
Social Phobia, also known as social anxiety disorder, is characterized by severe impairments in both social and occupational functioning. During the last years, much progress has been made in the understanding of factors contributing to aetiology and maintenance of social phobia as well as to its treatment. Important influences have been cognitive models of the nature of excessive social anxiety. In this symposium, new approaches to both the aetiology and treatment of social phobia are included. In the first paper, Luisa Stopa investigates the role of memory perspective and self-concept in social anxiety. It is pointed out that both concepts are important and necessary to clearly understand the nature of social anxiety. The second presentation by Rachel Mycroft and Colette Hirsch presents new data on the role of valence and self-reference of images in social phobia. Among other findings, they show that negative images of the self have the most powerful effect in increasing anxiety and impairing performance. The third presentation, by Ulrich Stangier and Thomas Heidenreich deals with a topic that has been neglected for some time: The role of secondary social anxiety in mental and physical disorders. Drawing on studies in populations as diverse as alcohol dependence, eating disorders, schizophrenia and body dysmorphic disorder, the authors point out the problems in identifying clinically relevant secondary social anxiety. The following two papers are dealing with treatment studies of social phobia: Sandra Mulkens, Susan Bögels, Peter de Jong and Judith Louwers present task concentration training, a newly developed treatment for social anxiety. They report on a randomized controlled trial comparing this treatment format with exposure in vivo in patients with fear of blushing. The final paper of this symposium is presented by Finn-Magnus Borge, Asle Hoffart and Harold Sexton who report results of a randomized controlled trial comparing cognitive-behavioral therapy with interpersonal therapy. The authors concentrate on the 6- and 12-month follow-up assessment points. The symposium concludes with a general discussion of future research directions in social phobia.
Luisa Stopa, University of Southampton, UK
Rachel Mycroft and Colette Hirsch, Institute of Psychiatry, London, UK.
Ulrich Stangier and Thomas Heidenreich, Frankfurt, Germany
Sandra Mulkens, Susan Bögels, Peter de Jong and Judith Louwers, Maastricht, The Netherlands
Finn-Magnus Borge, Asle Hoffart and Harold Sexton, Modum Bad, Norway
EXAMPLE OF A COMPLETE SYMPOSIUM
Diagnostic and Treatment Issues in Compulsive Hoarding
Convenor and Chair: Randy O. Frost, Smith College, USA
Patterns of comorbidity in compulsive hoarding
Todd Farchione, Boston University; David Tolin, Institute of Living, Hartford, CT; Sanjaya Saxena, UCLA; Karron Maidment, UCLA; Gail Stekteee, Boston University; Randy O. Frost, Smith College; Fugen Neziroglu, Bio-behavioral Institute, Great Neck, NY
Hoarding has been defined as the acquisition of, and failure to discard, possessions that appear to be useless or have limited value. Diagnostically, compulsive hoarding has been closely associated with both obsessive compulsive disorder (OCD); and obsessive compulsive personality disorder (OCPD) and symptoms of this condition can be found among a number of Axis I disorders, as well as in various forms of dementia. While recent research on the features of hoarding and its relationship with other psychiatric disorders has greatly improved our understanding of this condition, the diagnostic picture is far from complete and additional research is clearly needed. Clarifying the diagnostic features of compulsive hoarding is essential to our understanding of this disorder and has important treatment implications. Studies examining comorbidity, or the simultaneous occurrence of two or more disorders in the same individual, indicate that over 50% of patients with a principal anxiety disorder have at least one additional anxiety or mood disorder of clinical severity (Brown and Barlow, 1992). Even higher rates have been reported in investigations that include subclinical comorbid conditions. Results from these studies suggest that comorbidity has important implications for both classification and treatment outcome. Given these findings, examining patterns of comorbidity in compulsive hoarding is expected to shed some light on the diagnostic features of this disorder. In the current investigation, comorbid diagnoses will be examined in a group of patients receiving a principal diagnosis of OCD with primary symptoms of compulsive hoarding. Primary and comorbid diagnoses were assigned on the basis of information obtained through semi-structured or structured clinical interview. Consistent with previous findings from a study by Steketee and colleagues (2000), preliminary results from the current investigation suggest a high rate of comorbidity in this sample, with major depressive disorder and social phobia being most common. In an effort to examine the relationship between compulsive hoarding and OCD, the pattern of comorbidity in this sample will be compared to data obtained from a group of age and gender matched patients with non-hoarding primary OCD. The diagnostic and treatment implication of these results will be discussed.
Compulsive Hoarding – factors in its etiology, phenomenology and treatment; findings from an Australian study
Christopher Mogan and Michael Kyrios, University of Melbourne
Increasing research interest has identified compulsive hoarding as a distinct clinical phenomenon, with increasing agreement that it can be defined as the acquisition and failure to discard possessions that appear to be useless or of limited value, resulting in the clutter of rooms and the overall impairment of personal functioning (Frost and Hartl, 1996). An etiological model that specifies deficits in information processing (memory, decision-making, categorization), emotional attachments, behavioural avoidance, and beliefs about possessions has been posited (Frost and Hartl, 1996). Whilst this model has been supported by findings of differences between hoarders and clinical or non-clinical groups in specific beliefs about possessions, decision-making fears, and performance on tasks of organizational strategy and non-verbal memory in (Hartl et al., 2001; Kyrios et al., 2002; Steketee et al., 2003), there are still many unanswered questions about the etiology, nature and treatment of compulsive hoarding. This paper reports on: (a) a phenomenological study of compulsive hoarders in comparison with groups with non-hoarding Obsessive Compulsive Disorder, Social Anxiety or Panic Disorder, and controls using measures of hoarding behaviours and cognitions, emotional attachment and developmental factors, symptoms of OCD, affect, and personality disorder, and specific meta-memory measures; and (b) a pilot treatment program that tracks cognitive and symptomatic changes. This is the first study of hoarding in the Australian context, and one of the few attempts to replicate the efficacy of clinical interventions.
Group Treatment for Compulsive Hoarding
Jessica R. Grisham, Hyo-Jin Kim, Susan D. Raffa, , and Gail Steketee, Boston University; and Randy O. Frost, Smith College
Individuals with compulsive hoarding problems have been found to respond poorly to both behavioral and pharmacological interventions.The purpose of the current study was to evaluate a cognitive-behavioral group treatment for compulsive hoarding. In particular, we wished to identify which aspects of hoarding were resistant to treatment to further refine therapy for this population. To accomplish this, we compared hoarding-related symptoms before and after a cognitive-behavioral group treatment. The current sample consisted of 14 patients who participated in group therapy for compulsive hoarding at the Center for Anxiety and Related Disorders. Self-report measures of hoarding symptoms at pre-, mid-, and post- treatment were included. Measures included the Saving Inventory Revised (SI-R), the Saving Cognitions Inventory Revised (SCI-R), and the Beck Depression Inventory (BDI). The SI-R is a 23-item scale with a possible score ranging from 0 to 92, comprised of three subscales: clutter, difficulty discarding, and acquisition. The SCI-R was designed to measure hoarding-related thoughts and beliefs about possessions in several domains, including thoughts about control, memory, responsibility, and emotional attachment. Cognitive-behavioral group therapy for compulsive hoarding consists of 20 sessions, weekly for 3 months and then spaced out to twice monthly. In the current sample, treatment began with motivational interviewing and psychoeducation about the primary components of compulsive hoarding, including excessive acquisition, difficulty discarding, and problems with organization. Members also learned cognitive techniques to identify and challenge their hoarding-related thoughts. As the group progressed, members engaged in exposures to discarding their possessions both in session, and outside of session, as weekly homework assignments. In addition, members examined current acquisition behaviors and completed homework assignments related to reducing acquisition. Finally, therapists assisted patients in developing concrete problem-solving and organizational skills related to their possessions. Overall, the data suggest modest improvement in some domains, and limited change in others. Acquisition problems improved more than other areas of hoarding. One possible interpretation is that measures of clutter are less sensitive to change due to the longstanding nature of the problem and large accumulation of belongings, whereas measures of current behavior, such as acquisition, show more immediate improvement. Interestingly, beliefs about responsibility for possessions appear to improve rapidly. This may reflect the emphasis in group therapy on decreasing members’ feelings that they are responsible for their possessions or for excessive preparation in case of any shortages. While the current results suggest some optimism, they also point to slow and limited progress associated with this disorder.
Cognitive Behavioral Group Therapy for Hoarding: A Treatment-Outcome Study
Fugen Neziroglu, Jerry Bubrick and Merry E. McVey-Noble, Bio-Behavioral Institute, Great Neck, New York
Hoarding is a behavior characterized by the compulsive acquisition and/or saving of items without objective value. Currently, hoarding is categorized as a symptom of both Obsessive Compulsive Disorder and Obsessive Compulsive Personality Disorder. It has also been identified as a symptom within anorectic and schizophrenic populations. Though it has been clearly linked with disorders within the Obsessive Compulsive Spectrum, hoarding has more recently been conceptualized as a possible disorder in and of itself. Hoarding, whether as a symptom or syndrome, has been noted to lead to significant functional impairment and subjective distress, posing tremendous difficulties for both the hoarders themselves, and for their families and loved ones. Severe hoarding can lead to limited functional space in the home, isolation and family and marital discord. In addition, the emotional sequelae of pathological hoarding include feelings of extreme anxiety, embarrassment and depression on the part of the hoarder. In the past, two decades, there has been a paucity of clinical and empirical literature on the treatment of hoarding. Recently, a protocol for the group treatment of severe hoarding was developed and piloted at the Bio-Behavioural Institute in Great Neck, New York. The protocol was weekly sessions of 90 minutes for a duration of 12-weeks. Psychoeducation and cognitive behavioural techniques targeting specific reasons for hoarding were implemented. Some reasons for hoarding can be indecisiveness, lack of prioritizing, disorganization, and poor attention span. Finally, group members participated in specific behavioural exercises designed to assist in the discarding of hoarded materials. The group was 12 weeks in duration, and participants included five females and 4 males, age 41 to 63 years. All of the participants had acquired at least some college education and four of the nine had obtained graduate degrees. Despite this, only one of the group members was employed, indicating their severe functional impairment. Regarding the extent of their hoarding, eight out of nine participants reported that they felt they needed additional storage space for their possessions, and five out of the nine reported actually having taken steps to obtain more space. Overall, participants demonstrated improvement on indices of anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-2) and savings behaviour (Savings Behaviour Inventory) at weeks four and eight. However, these measures returned almost to baseline at week 12. Reasons for this phenomenon are explored as well as suggestions are made on how to improve group treatment.
EXAMPLE OF HALF DAY WORKSHOP
Family Cognitive Behavioural Therapy for anxiety disorders in children and adolescents.
Susan Bögels, University of Maastricht, The Netherlands
Who the workshop is aimed at: Experience in cognitive-behavioural treatment of anxiety (in adults and/or children) is needed in order to follow this workshop.
Background: Anxiety disorders run in families; an overlap of 60-80% has been found between parental and child anxiety disorders. Next to genetic factors, “anxiety enhancing” parenting behaviours, like modelling of anxious behaviour, overprotection, and restriction of open expression of opinions and feelings, seem to contribute to this relationship. Family CBT has been found equally effective or more effective in treating child anxiety disorders, and is potentially more cost-effective because more family members are treated at the same time. The goal of family CBT is to decrease child anxiety, parental anxiety, and anxiety-enhancing parenting.
The goal of the family CBT that is outlined in the present workshop consists of three components:
(i) Teaching CBT skills to the anxious child and both parents, the parents being encouraged to use these skills to guide their anxious child and to cope with their own fears (4 sessions).
(ii) Modifying dysfunctional beliefs between parents and child that block the process of change, that is, parental beliefs about their anxious child, parenting, and the safety of their child’s world –often based on their own upbringing or anxiety-, and child’s dysfunctional beliefs about the parents and about the possibility and usefulness of communication with them (4 sessions).
(iii) Improving communication and problem solving, between spouses about their child’s anxiety, and between all family members, including siblings (4 sessions).
Learning Objectives: Participants will acquire the following skills:
1) Conducting a family conversation in order to orient the family towards the treatment goals
2) Coaching parents in guiding their anxious child (e.g. through courageous modelling)
3) Identifying and challenging dysfunctional parental cognitions about the anxiety of their child and their role as a parent
4) Conducting a family discussion on a “hot issue”
Teaching Methods: In this workshop the three components of the treatment will be taught through instruction, modelling, and practice (role-plays).
Workshop Leader: Susan Bögels (clinical psychologist/psychotherapist) works as a researcher and practitioner in the area of child and parental anxiety disorders. One of her major themes of interest is how parents of anxious children influence the anxiety of their child through their own dysfunctional beliefs, their own upbringing, and the interaction between parental and child anxiety. She is currently conducting a Randomised Clinical Trial in 8 centers of child psychiatry in Holland, to compare the effects of family CBT with child CBT for children and adolescents with clinical anxiety disorders.
1. Barrett, P. M., Dadds, M. R., and Rapee, R. M. (1996). Family treatment of childhood anxiety: a controlled trial. Journal of Consulting and Clinical Psychology, 64, 333-342.
2. Ginsburg, G. S., Silverman, W. K., and Kurtines, W. K. (1995). Family involvement in treating children with phobic and anxiety disorders: A look ahead. Clinical Psychology Review, 15, 457-473.
3. Siqueland, L., and Diamond, G. S. (1998). Engaging parents in cognitive behavioral treatment for children with anxiety disorders. Cognitive and behavioural practice, 5, 81-102.
EXAMPLE OF SKILLS CLASS
Assessing and treating a Specific Phobia of Vomiting
David Veale, Instiute of Psychiatry, Kings College London
Background: A Specific Phobia of Vomiting (SPOV) commonly develops in childhood with a mean duration of about 25 years and occurs almost exclusively in women (Veale and Lambrou, 2006; Lipsitz and Fyer, 2001). Clinicians generally regard SPOV as more difficult to treat and different in psychopathology compared to other specific phobias. People with SPOV tend to be more handicapped than people with other specific phobias (for example avoidance of a desired pregnancy or being significantly underweight from restriction of food). There is very little research in SPOV and no controlled trials in SPOV. It is however possible to use many of the advances in other disorders such as OCD and health anxiety for understanding the factors that maintain the preoccupation, distress and handicap in SPOV. Our team provides a national service for treating SPOV and we are developing a research programme for assessing and treating SPOV. A SPOV is not a common specific phobia that presents for therapy but when it does most therapists seek help as patients may be difficult to engage. By the end of the class participants will be able to apply what they have learnt in the class to their everyday practice in treating SPOV and generalise some of the principles to other anxiety disorders.
Learning Objectives: By the end of the class, participants will be able to:
1. Diagnose a Specific Phobia of Vomiting (and differentiate it from an eating disorder; OCD; health anxiety; panic or social phobia).
2. Make a developmental formulation which can be used in engagement
3. Describe a cognitive behavioural formulation and model for treating SPOV
4. Use new assessment measures for monitoring SPOV
5. Use a variety of strategies from imagery rescripting, exposure in imagination and in vivo, and behavioural experiments for dropping of safety and avoidance behaviours.
Skills Class Leader: David Veale is a Consultant Psychiatrist in CBT at the South London and Maudsley Trust and The Priory Hospital North London. He is an Honorary Senior Lecturer at the Institute of Psychiatry, Kings College London. He is a Consultant at the Bethlem Royal Hospital which provides a national out-patient and residential service for people with SPOV and at the Priory Hospital North London which provides a specialist in-patient service for SPOV. He has published about 70 peer-reviewed articles (mainly in OCD and BDD) and three self help books.
Boschen, M. J. (2007). “Reconceptualizing emetophobia: a cognitive-behavioral formulation and research agenda.” Journal of Anxiety Disorders 21(3): 407-19.
Lipsitz, J. D., A. J. Fyer, et al. (2001). “Emetophobia: preliminary results of an internet survey.” Depression & Anxiety 14(2): 149-52.
Veale, D. and C. Lambrou (2006). “The psychopathology of vomit phobia.” Behavioural and Cognitive Psychotherapy 34(2): 139-150.
Veale, D. (in submission). Treating a specific phobia of vomiting. The Cognitive Behaviour Therapist.
EXAMPLE OF A PANEL DISCUSSION
Common Language In Psychotherapy (CLiP) Project
Chair: Mehmet Sungur, Medical School of Marmara University, Dept of Psychiatry, Istanbul, Turkey
One of the main requirements for the evolution of psychotherapy from art into a science is to establish a common psychotherapy language. At present, similar procedures are given different names by different schools or the same label (name) may denote different procedures in different hands. The EABCT and AABT have recognized the need to reduce this confusion by appointing a joint task force to work on a project towards a common psychotherapy language. Panel members will outline the project. It aims to evolve a dictionary of psychotherapy procedures of therapists from different schools, with the hope of encouraging shared use of the same terms for given procedures. A common language might reduce confusion and facilitate scientific advance in the field. The project will use plain language. It will not lead to an encyclopaedia or textbook or theoretical exposition of psychotherapies. The dictionary will concisely describe terms for a comprehensive set of psychotherapy procedures in simple language as free from theoretical assumptions as possible, each with a brief case example (up to 450 words), note of its first known use, and 1-2 references. The terms will try to describe what therapists do, not why they do it (the latter too is important and could be the subject of a separate project). Regular updates of the Dictionary will be aimed at via the CLiP website that should operate shortly. Submissions will be invited of 1st-draft entries of terms to the clip task force. The Panel will describe the project’s significance and hoped-for outcome, give examples of completed entries and their authors, and how to make 1st-draft submissions and the iterative process toward their completion. Most of the Panel’s 1.5 hours is expected to be taken up by audience feedback to help shape the project even further.
EXAMPLE OF A CLINICAL ROUNDTABLE
Formulation and Treatment Planning for Trauma Focused CBT for CPTSD: When & How to Adapt Treatment?
Convenor: Martina Mueller & Alison Croft, Oxford Cognitive Therapy Centre (OCTC), United Kingdom
Chair: Melanie Fennell, University of Oxford, United Kingdom
Speakers: Patricia Resick, Duke University Medical Centre, USA; Anke Ehlers, University of Oxford, United Kingdom; Regina Steil, Goethe University Frankfurt, Germany
Whilst trauma focused CBT is helpful for many patients with PTSD, some populations do less well. Survivors of multiple and cumulative trauma often present with severely disabling and pervasive difficulties, which can pose significant dilemmas for clinicians. ICD – 11 includes a formal diagnostic classification to describe the sibling diagnosis of CPTSD, which describes additional clinical features associated with severe trauma. However, an ongoing controversy regarding the most appropriate treatment approaches for complex PTSD (eg. De Jongh et al., 2016) fuel practising clinicians’ ambivalence about the choice and timing of key therapeutic strategies to aid recovery. Clinicians often have questions such as: When is disturbance of affect severe enough to warrant adaptations to treatment? How can we assess this systematically? What do we do when there are many troublesome memories to different events, memories ‘bleed’ into each other or meaning has become generalised and entrenched? How do we safely work with the ready activation of extreme affective arousal, such as the defence cascade?
The convenors propose to present the case of ‘Molly’ a survivor of multiple, life long trauma who presents with CPTSD (ICD-11). The clinical presentation will describe a detailed case formulation and treatment planning and will highlight options for resolving clinical obstacles.
Reference: De Jongh, AD et al. (2016) Critical analysis of the current treatment guidelines for complex PTSD. Depression & Anxiety, 00:1-11.
Implications for everyday clinical practice of CBT
This Clinical Roundtable aims to offer practising clinicians an opportunity to reflect on expert opinion on resolving common obstacles in the treatment of CPTSD, to inform case formulation and treatment planning. The discussion will aim to focus on some of the following questions:
- How do we best conceptualise and make clinical decisions about treatment planning with the most complex trauma cases?
- What tools do we have for working effectively and safely with multiple and cumulative trauma memories?
- How can clinicians approach work with very high and readily triggered arousal and over-engagement with trauma memories?
These questions are salient for the treatment of a wide range of clinical populations including: Traumatized refugees, survivors of developmental trauma and domestic violence as well as occupationally traumatised personnel.
EXAMPLES OF OPEN PAPERS
a) Neuroimaging and CBT in anxiety disorders
Prasko, J., Horacek, J, Paskova, B. Prague Psychiatric Centre; 3rd Medical Faculty of Charles University and Centre of Neuropsychiatric Studies, Prague, Czech Republic Praskova, H., Out-patients Psychiatric Clinic, Horni Palata, Prague, Czech Republic
Neuroimaging studies on anxiety disorders is at relatively preliminary stage. Nevertheless, findings are arguably consistent with involvement of limbic, paralimbic, and prefrontal regions. In studies with positron emission tomography (PET) patients suffering with GAD have increased relative metabolic rates in the right posterior temporal lobe, right precentral frontal gyrus, and left inferior area 17 in the occipital lobe but reduced absolute basal ganglia rates (Wu et al. 1991). Imaging studies that have pooled or compared findings across different anxiety disorders may also shed light on the underlying neuroanatomy of anxiety symptoms that are not disorder specific. An analysis of pooled PET symptom provocation data from patients with OCD, PTSD, and specific fobia, for example, reported activation of paralimbic structures (right posterior medial orbitofrontal cortex, bilateral insular cortex), right inferior frontal cortex, bilaterl lenticulate nuclei , and bilaterl brain-stem foci (Rauch et al. 1997). There is growing realization of the importance of various CSTC loops in a range of behavioral disorders (cortico-striatal-thalamic-cortical circuit), particularly in relation to certain kinds of cognitive affective cues, and appear most relevant in OCD. Functional imaging studies provide some of the most persuasive evidence of the role of CSTC circuits in OCD. Patients have increased activity in the orbitofrontal cortex, anterior cingulate, and basal ganglia (Rauch and Baxter 1998). Additionally, question remain about precise nature of CSTC dysfunction in OCD and its normalization by effective treatment. Decreased orbitofrontal activity in OCD predicts positive response to pharmacotherapy, whereas higher orbitofrontal activity predicts positive response to behavioral therapy (Brody et al. 1998). Preliminary evidence from brain imaging shows the importance of amygdala and paralimbic structures in panic disorder. CT study suggested prefrontal abnormalities (Wurthmann et al. 1998), a SPECT study showing asymmetry of inferior frontal cortical perfussion (De Cristofaro et al. 1993). Although it has been hypothesized that cognitive-behavioral therapy exert effects in panic disorder by behavioral desensitization of hyppocampal-mediated contextual conditioning, or by cognitive techniques tha strengthen medial prefrontal cortex inhibition of amigdala (Gorman et al. 2000), the relevant empirical studies have not yet been undertaken. We will present preliminary PET data of 12 patients with panic disorder. Patient were measured before and after therapy with antidepressant or CBT. The finding will be discussed, compared with results of other studies and showed with accordance of neurobiological theories.
b) Relationships between schemas (Young’s model) and the bis/bas individual differences (Gray’s model).
Cid, J, Servei de Rehabilitació. Parc Hospitalari Marti i Julià. I.A.S. Girona ; Torrubia, R, Unitat de Psicología Mèdica. Universitat Autònoma de Barcelona. Barcelona.
Schemas have a central role in cognitive psychopathology. In fact, a cognitive model assumes that schemas are developed in response to biological predispositions and environmental influences. However, little is known in terms of empirical data with regard to how they are related to biological or temperamental variables. Furthermore, the cognitive-behavioural case conceptualization has not usually taken into account the influence of temperamental variables. Nowadays, there are several approaches both to the study of schemas (e.g. Beck et al., 1990; Arntz, 1999; Young, 1990) and to the study of biological or temperamental bases of personality (e.g. Gray, 1988; Cloninger, 1986, 1987). The theoretical frameworks of our research were the schema-focused model (Young, 1990) and Gray’s personality model. The first defines schemas (Early Maladaptive Schemas, EMS) as “broad, pervasive themes regarding oneself and one’s relationship with others, developed during childhood and elaborated throughout one’s lifetime and dysfunctional to a significant degree” (Young, 1994). Gray’s model of personality, includes two neuropsychological systems, the Behavioural Inhibition System (BIS) and the Behavioural Activation System (BAS) which underlie the personality dimensions of anxiety and impulsivity, respectively. The aim of this study was to investigate the psychometric relationships between schemas and the individual differences in the activity of BIS and BAS. A total of 115 psychiatric patients from a Catalonian Mental Health Centre were included in the study. To evaluate schemas, we used the Spanish Version of the Young Schema Questionnaire (Cid, Tejero and Torrubia, 1999; Cid and Torrubia, 2001); this is a 205-item self-report that assesses 16 early maladaptive schemas. To evaluate individual differences in BIS/BAS, we administered the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ, Torrubia, Avila, Moltó, and Caseras; 2001). Statistical analyses consisted of a Principal component analysis with Varimax rotation including schema and personality scales, and a multiple regression analysis using the Sensitivity to punishment (SP) and Sensitivity to reward (SR) scales as independent variables, and each schema as a dependent variable. Principal component analysis yielded three factors with eigen values higher than 1 which accounted for 69.19 % of variance. The first was loaded by SP and the schema scales Failure, Social Undesirability, Dependence, Defectiveness, Social Isolation, Insufficient Self-control and Subjugation, the second by the schema scales Self-sacrifice, Unrelenting standards, Emotional deprivation, Mistrust, Emotional inhibition, Abandonment and Vulnerability to harm and illness, and the third by SR and the schema scales Enmeshment and Entitlement. Results from multiple regression analyses showed that SP and SR scales accounted for a significant percentage of variance in all of the schemas. In the discussion, we develop the implications of these results for the assessment, case conceptualization, and cognitive-behavioural treatment of personality disorders.
EXAMPLES OF POSTERS
a) Black women’s’ phenomenological experience of providing home-care for a family member with AIDS in a third world context
Basson, P.J. and Whelan, M. Rand Afrikaans University
World statistics show that HIV infection is on the increase. Much attention is thus currently paid to the prevention of AIDS. A growing problem, however, is the increasing number of people in the terminal phase of HIV – especially in developing countries like South Africa. During this phase of the illness serious infections manifest themselves and there is a general decline in the patient’s functioning, leading to increased dependence on others for activities of daily living. Often these people in the final phase of HIV are accommodated in hospitals and hospices. Due to rising health care costs, inadequate and understaffed facilities and overwhelmed health care workers, more and more people in the final phase of HIV are cared for at home. In most developing and third world countries home-based care becomes the responsibility of illiterate, uneducated family members of infected individuals, with little or no resources to provide terminal care. For this reason a phenomenological study was conducted in order to expose the experience of providing care for a family member in the final phase of HIV. Five black female care givers were included in this study. Common themes that emerged from the transcribed interviews included the establishment of an existential baseline as well as diminished independence and freedom of participants. They also expressed the need for support (emotional, financial and medical). Lastly religion and certain coping mechanisms were found to either facilitate or hinder the provision of care, depending on their rigidity and effectiveness respectively.
b) The relationship between delusional ideations and stress coping in Japanese college students.
Syudo Yamasaki, Hiromi Arakawa, Yoshihiko Tanno, Graduate school of Arts and Sciences, University of Tokyo
Introduction : Delusional ideation is one of the symptoms in schizophrenia. In many recent studies, delusional ideation in general population has been investigated. These studies found that there were more people with delusional ideation in general population than that had been expected. However, there were a few studies about the relationship between delusional ideation and stress coping style in healthy samples. Schuldberg et al. (1996) found that psychosis-prone individuals used more coping by Escape-avoidance and Accepting responsibility. In the present study, we tried to examine the relationship between delusional ideation and stress coping style in Japanese college students. Method: The Japanese version of Peters et al. Delusions Inventory (PDI; Yamasaki et al. 2004) and Lazarus Type Stress Coping Inventory (SCI; Lazarus and Folkman, 1984; Motoaki et al. 1991) were administered to 154 college students (106 men and 48 women with mean age±SD of 19.2 ± 0.9). The Japanese version of PDI was consisted of 40 items, which was including assessing measures of presence of ideation, distress, preoccupation and conviction for each item. PDI has four dimensions of delusional ideation. SCI has eight subscales of stress coping (Planful problem solving, Confrontive Coping, Seeking Social Support, Accepting Responsibility, Self-controlling, Escape-avoidance, Distancing, Positive Reappraisal). Results: Correlation coefficients between four dimensions of PDI and eight subscales of SCI were examined. Distress of delusional ideation has positive correlations with escape-avoidance coping (r = 0.23, p < 0.01), Accepting responsibility (r = 0.19, p < 0.05) and Seeking Social Support (r = 0.20, p < 0.05). Distress of delusional ideations has negative correlations with Self-controlling (r = – 0.18, p < 0.05), Positive Reappraisal (r = – 0.20, p < 0.05) and Planful problem solving (r = – 0.20, p < 0.05). The number of presence of delusional ideations was positively correlated with Accepting responsibility (r = 0.22, p < 0.01). Conclusions: In the present study, the result of Schlberg et al. could be replicated in college students. Escape-avoidance and Accepting responsibility coping has positive correlations to distress of delusional ideations. On the other hand, Self-controlling, Positive Reappraisal and Planful problem solving has negative correlations to distress of delusional ideations. Patients with schizophrenia tend to use passive and avoiding coping strategies in stressful situations rather than problem solving coping (Gispen-de Wied, 2000). The result of present study also suggested that delusion-prone college students had the same pattern of coping strategy as the previous studies.
c) Expressed Emotion and Parasuicide
Santos, J.C.P., Bissaya Barreto Nursing School, Portugal, Saravia, C.B., Coimbra University, Portugal, and Sousa, L., Oporto University, Portugal.
Parasuicidal and suicidal behaviour are increasing a lot in some Western countries and are considered a public health problem. Parasuicide occurs mainly in the age group between 15 to 24 years old and therefore it is a priority to study this population group. Expressed Emotion is not a concept that has been studied in these behaviours, although it has been used in other pathologies over the last 30 years. Expressed Emotion is assessed through a semi-structured interview using five scales: hostility, over-involvement, critical comments, warmth and positive comments. This is a prospective study carried out over nine months. The results presented here refer to the first contact, the first week after the Parasuicide behaviour, and research is still in progress. The sample consisted of relatives of 35 individuals (aged between 15 to 24, who committed parasuicidal behaviour), residents in the city of Coimbra and its surrounding areas (in the central region of Portugal). Our first contact was made in the Accident and Emergency Department (from 15 th September 2003 to 31 st March 2004), with people whose cause of admission was parasuicidal behaviour. After this we carried out interviews with the family, in the first week after the parasuicidal behaviour. We used the Camberwell Family Interview (Leff, J and Vaughn, C, 1985) for the interviews which were taped and analysed after. The general aim is to characterise the Expressed Emotion of the family members of those individuals who have parasuicidal behaviour. The sample of 35 parasuicidal individuals was predominantly female with an average age of 19 and who were mainly students. Almost all were single (91,4%). The vast majority of the sample (88,5%) had parasuicidal behaviour involving drug overdose and for the majority (57,2%) this was their first attempt. Out of a total of 57 interviews carried out with relatives and other important people in the lives of the parasuicidal individuals, 31 showed a high EE and 26 a low EE and we classified 26 families with high EE. The interviews lasted on average 50 minutes with a minimum of 30 minutes and a maximum of 90 minutes. We found evidence of high emotional over-involvement in 23 of the situations studied. There was a high level of criticism in 19 with hostility also present in 7 interviews. Some of them had high levels in more than one of the scales. The presence in the results of high levels of EE, particularly emotional over-involvement did not confirm the data obtained by Pollard (1996) who found a higher presence of criticism and hostility rather than emotional over-involvement. We can characterise the behaviour of over-involvement mainly through excessive self-sacrifice and statements of attitude. Critical comments were present suggestion situations involving traits and states according to the cases. The situation that we found has not permitted us, yet to draw generalised conclusions with regards to the stability or development of the critical comments and EE. With regards to hostility, the majority of the situations can be characterised by the presence of generalised criticism and rejecting remarks together. Leff (1989) says that in general the study of EE in any situation requires us: to study the relationship between EE and pathology; to draw up an adequate intervention plan and finally to analyse the appropriateness of the intervention model in a clinical context. In the case of parasuicidal behaviour the assessment of our EE research carried out shows the presence of a high EE mainly through over-involvement which we would like to highlight. We also found high levels of criticism. The research will continue to characterise better the relationship between parasuicidal behaviour and EE.
EXAMPLE OF A TECHNICAL DEMONSTRATION
The SO REAL Project: Cognitive Behavioral Therapy Augmented with Virtual Reality Exposure Therapy for Social Anxiety Disorder
Presenters: Benjamin Arnfred & Peter Bang, Center for Mental Health Capital Region of Denmark, Denmark
Virtual Reality (VR) is a media which allows the creation of artificial environments, which are perceived as real or almost real, due to multisensory stimulation and blocking of real world sensory input. As a therapy tool, VR is most widely used and has shown the best results through Virtual Reality Exposure Therapy (VRET). In VRET, part of or all the exposure a patient receives is administered through VR, instead of in-vivo. New meta-studies support that VR is an effective tool that can improve exposure therapy for Social Anxiety Disorder (SAD) (Carl et al., 2018; Chesham, Malouff, & Schutte, 2018)
Exposure therapy has been shown to be effective in treating SAD, especially when it is part of Cognitive Behavioral Therapy (CBT).
However, exposure therapy for SAD can be costly to structure logistically, and troublesome to control and graduate. In addition, many clients with SAD are so fearful that they will avoid treatment when they must face feared situations in-vivo. Virtual Reality Exposure Therapy (VRET) might enable us to circumvent some of these problems, by making it possible to expose patients to their feared situations in the therapy room via VR equipment.
Five 360 degree VR films has been shot and edited to be used in VRET for SAD. Each film depicts a typical social anxiety inducing situation and consists of four to five scenes of approx. 2 minutes length, which allows the therapist to graduate the exposure.
The films are played on an Occulus Go connected to high quality headphones. The Occulus Go places a screen in front of the users face which almost fully takes up their field of view, while simultaneously blocking out visual sensory input from the real world. Motion detectors in the Occulus Go allows the user to look around the films as they play in 360 degrees around them. To maximize ease of use for both the client and the therapist, an app for the Occulus Go has been developed which allows the user to choose the scenes they wish to see in an intuitive and simple interface. The technical demonstration will give a brief overview of the equipment and its intended use and then allow attenders to try the Occulus Go and see the films themselves.
Though current research supports the effiacy of VRET for SAD, there is still a lack of high quality RCT’s in this field. The SO-REAL project will be the largest RCT to date (N=302) to investigate the efficacy of CBT augmented with VRET for SAD.
Implications for everyday clinical practice of CBT
CBT augmented with VRET for SAD might increase therapy adherence, increase user acceptance of exposure therapy, reduces risk of confidentiality breaches and reduce costs associated with transport and timing (e.g. going to the supermarket in the early or late hours as an early exposure step).