goodmedicine

Third and last day of the full conference.  In fact we finish at lunch time today.  Up, then an interesting conversation about bipolar disorder at breakfast.  It's fun how I can chat with almost any of the well over 1,000 conference participants and almost certainly we'll have a whole lot of helpful shared experiences and insights to explore.  Then off to an in-conference workshop on Positive psychology based interventions.  Sadly there's a notice on the seminar room door saying the workshop has been cancelled due to illness.  Oh dear, I hope the would-be presenter Ilona Boniwell (or any ill members of her family) get well soon.  What a pity.  It's been a feature of this year's BABCP conference that a number of research papers on positive psychology interventions have begun to emerge.  So, flipping through the conference programme, presentations that appear to overlap into this area include: Developing the role of psychological wellbeing practitioners; If it feels good, do what? Developing an inventory of responses to positive feeling states; Positive emotions in bipolar disorder; Authenticity and well-being; Gratitude and well-being; Let's not run before we can walk: exploring the potential for gratitude interventions in self-directed therapy; Resilience to suicide: the role of positive appraisals; and this now cancelled workshop on Positive psychology based interventions.  Besides these eight presentations there are also eight or nine involving mindfulness, and a further eight or so about compassion.  A few years ago there would have been nothing about any of these topics.  It will be fascinating to follow these developments and see what becomes solidly established in the cognitive therapists' therapeutic tool bag and what withers under the light of further research.

Ilona Boniwell's workshop description ran: "Positive psychology is a rapidly developing field addressing factors that promote flourishing and optimal functioning in individuals and communities. It brings empirical research into the areas of well-being, happiness, flow, personal strengths, wisdom, creativity, imagination and the characteristics of positive groups and organisations.  One of the stated workshop objectives was to: critically discuss the usefulness of positive psychology interventions for CBT therapists".  Particularly after reading Sin & Lyubomirsky's recent paper "Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis", I'm sorry to have missed this workshop. 

However it does mean I can get to another symposium that looks good - "Using imagery and chair dialogue to rescript early maladaptive cognitive patterns".  The symposium convenor, Dave Edwards, quotes Aaron Beck as saying - in the early '90's - "Cognitive change occurs in the fires of affect", and cites John Teasdale's 1993 paper "Emotion and two kinds of meaning: cognitive therapy and applied cognitive science" as key in development of these more emotion-focused CBT interventions.  He also points out how some of these ideas have a lineage that goes back to Gestalt Therapy, with Paul Gilbert citing Les Greenberg as a major source for the chair dialogue work he uses, and Greenberg himself developing these approaches from Fritz Perls.  Then the queen bee of UK CBT imagery, Ann Hackmann, presented a nice case study on treating delayed onset PTSD.  It was good to be reminded of how often Ann will go with the PTSD sufferer to visit the place where the original trauma occurred.  I have done this very occasionally.  It's time consuming but well worth bearing in mind as a therapeutic option.  Jon Wheatley then discussed a hugely impressive case study using imagery approaches to help a woman with very serious depression.  It took 19 sessions focussing almost entirely - due to the research protocol - on imagery work, to achieve success.  But with the history the woman described, this was fast therapy!   I gather the case is described more fully in Nick Grey (ed) "A casebook: cognitive therapy for traumatic stress reactions".  Dave Edwards himself then presented on helping a young woman with anorexia.  Case studies are fascinating.  Going quite deeply into a particular piece of therapeutic work unpacks so much rich and potentially helpful detail - especially when there is also video or audio recording to bring the material even more to life.  The quantitative research is absolutely crucial, but qualitative work is rich in information too.  Points for me to take away include the probable importance of a clear (mutually developed) case conceptualisation to guide experiential work - with this experiential work then potentially feeding back to improve the conceptualisation.  Well worth also considering tracking before and after changes in key dysfunctional beliefs pretty much whenever one does a bit of significant rescripting work.  As a senior schema-focused worker, Vartouhi Ohanion, was quoted as saying, one may need to repeat, repeat, and repeat work aimed at changing underlying schema.  In the trial comparing emotion-focussed therapy (EFT) with CBT in depression treatment, it was noteworthy that over 16 weekly therapy sessions, EFT clients probably received at least half a dozen emotion eliciting dialogue/imagery intervention experiences.  In the linked paper on emotional processing in psychotherapy, Watson and Bedard reported "Clients in the good outcome group in both PET and CBT for depression begin, continue, and end therapy at higher modal and peak EXP (emotional experiencing/processing) levels than clients in the poor outcome group. Good outcome clients in both groups engaged in deeper exploration, referred to their emotions more frequently, were more internally focused, and examined and reflected on their experience to create new meaning and resolve their problems in personally meaningful ways. In contrast, clients with poorer outcomes were not as engaged in processing their emotional experience. These clients did not pose questions about their experience or purposively examine it to understand the origins and implications of their experience more fully. They did not reflect on their experience, nor did they report important shifts in perspective or feeling during the session". It's as if one is working to create a virtual world of new experiences and new meanings.  It's probably worth remembering that memories of the so-called real world are also, in significant ways, created.  See, for example, studies by Heir et al (2009), Wood et al (2006), McAdams et al (2006), Hepp et al (2006), and Hyman et al (1998).  As Jon Wheatley's client commented "It was as if the imagined rescripted memories in some sense actually happened".

Then to a final plenary presentation with Paul Gilbert talking on "The challenges of life and the development of compassion".  I've done several days of workshops with Paul, but still good to be reminded of how aversive and anxiety-provoking it can be for people who are very self-attacking to even consider being kinder to themselves.  Paul's model of fear, reward and contentment mechanisms in the brain seems interesting and helpful.  Worth developing a diagram of this and using it as orientation when doing a desensitisation hierarchy for compassion-phobic clients!  Finally the last words from Roz Shafran and Warren Mansell.  Great.  A good conference that leaves me with a whole bunch of ideas and approaches to follow up.