CBT FOR CHILDREN, YOUNG PEOPLE AND FAMILIES:

Addressing the challenges faced by users and practitioners in accessing and providing services

10-11 April 2013

University of Birmingham

Pre-Conference Workshops on 10th April

Workshop 1: Cognitive Behavior Therapy with Youth: Blueprints, tools, and therapeutic know how

Robert D. Friedberg, Ph.D., ABPP

Center for the Study and Treatment of Anxious Youth at Palo Alto University

co-author of Clinical Practice of Cognitive Therapy with Children and Adolescents: the Nuts and Bolts and Cognitive Therapy Techniques for Children and Adolescents: tools for Enhancing Practice

Cognitive behavior therapy (CBT) with youth is a popular and growing treatment method. Various clinical trials, empirical studies, and case reports document its effectiveness for a variety of clinical disorders. While many clinicians are drawn to CBT, some therapists do not apply the approach properly. Improper application of CBT may be due to an incomplete theoretical understanding of the approach, ineffective use of procedures, and lack of clinical alertness. This workshop teaches participants the conceptual base of CBT (blueprints), ways to apply its techniques (tools) within a clinically astute framework (know how).

The workshop begins with a brief summary of CBT’s fundamental tenets (learning theory, content-specificity, hierarchical organizational model). The importance of collaborative empiricism, guided discovery, transparency, immediacy, and presence are illustrated. A variety of traditional and innovative techniques for modifying thought and action patterns are taught within the context of modular CBT. The concepts, principles, procedures and clinical processes are illustrated through numerous case examples. Attendees will receive detailed handouts and materials.

Workshop 2: Cognitive Behavioral Therapy of Obsessive-Compulsive And Related Disorders

Sabine Wilhelm, Harvard Medical School, USA

Who the workshop is aimed at: Mental health service providers who wish to learn how to treat youth with OCD, body dysmorphic disorder, skin picking disorder and related disorders

Several disorders are considered to be related to obsessive compulsive disorder (OCD) and are therefore known as obsessive-compulsive (OC) spectrum disorders. While the OC-spectrum disorders’ concept continues to evolve, proposed psychiatric disorders have included (but are not limited to) OCD, body dysmorphic disorder (BDD), and skin picking disorder. The need to educate mental health service providers about recent advances in the treatment of these disorders is great: OC-spectrum disorders are common, and they are associated with severe distress yet are poorly understood.

The presenter will first describe how to correctly recognize, diagnose, conceptualize youth with OCD spectrum disorders. Participants will then be trained in a range of therapeutic techniques for OCD including: exposure and ritual prevention, cognitive strategies, metaphors and mindfulness exercises. Attendees will learn how to use the treatment model with different forms of OCD (e.g., checking, mental compulsions). Clinicians who become known in their community as OCD specialists are often referred patients who engage in various kinds of maladaptive repetitive behavior. Therefore, the presenter will next illustrate how the principles used to guide the cognitive behavioral treatment of OCD can be modified and applied to treat conditions that have some similarities to OCD. We will focus on BDD, skin picking disorder and tic disorders. Novel strategies to reduce these maladaptive behaviors (e.g., perceptual retraining for BDD) will be discussed. Strategies for involving patients’ families (e.g., helping family members stop accommodating the child’s compulsions) will also be reviewed. In addition, motivational strategies for helping youth overcome resistance to treatment will be presented. Finally, relapse prevention strategies will be discussed.

Key Learning Objectives:

  • How to recognize, diagnose, assess and conceptualize OCD and related disorders
  • How to design various cognitive and behavioral treatment strategies, which will allow the patient to develop new ways of thinking as well as new ways of behaving
  • How to engage youth in CBT for OCD and related disorders

Teaching Methods: In this workshop the assessment and treatment of OCD and related disorders will be taught through instruction, interactive discussion of specific cases, modeling, and practice (role-plays).

Workshop Leader: Sabine Wilhelm, is an Associate Professor at the Harvard Medical School and Director of the Obsessive Compulsive Disorder (OCD) and Related Disorders Program at the Massachusetts General Hospital. She is an internationally recognized leader in the treatment of BDD and OCD, and has over 140 publications on this topic. In addition, she authored and co-authored books on the treatment of OCD, BDD and tic disorders.

Recommended Readings:

Greenberg JL, Markowitz S, Petronko MR, Taylor CE, Wilhelm S, Wilson TG. Cognitive

behavioral therapy for adolescent body dysmorphic disorder. Cogn Behav Pract 2010; 17(3):248-258.

Piacentini J, Langley, A, Roblek T. Cognitive-Behavioral Treatment of Childhood OCD: It's Only a False Alarm: Therapist Guide. New York, NY: Oxford University Press (2007).

Woods D, Piacentini J, Chang S, Deckersbach T, Ginsburg G, Peterson A, Scahill L, Walkup J, Wilhelm S. Managing tourette syndrome: A behavioral intervention for children and adults: Therapist guide (Treatments that work). New York, NY: Oxford University Press (2008).

Workshop 3: Mindful Parenting.

Prof. Dr. Susan Bögels is a clinical psychologist and psychotherapist, specialized in Cognitive Behaviour Therapy for children and their families. She works as professor in developmental psychopatholoy at the University of Amsterdam and is the director of the academic treatment clinic for parents and children in Amsterdam.

Mindfulness training is an intervention based on eastern attention/meditation techniques, which helps developing a wide, open awareness as well as focused attention, and reducing automatic responding. Mindful Parenting is a specific application of mindfulness, for parents who have (had) mental health problems that interfere with parenting, or whose child or children have mental health problems. In this workshop the theory and rationale, the program details, and effects on parental and child psychopathology, parenting stress, and (co)parenting, of the 8 sessions mindful parenting group training, are reviewed. By means of meditation practices, in which participants place themselves in the role of parents, the most important practices that we have found to be helpful in teaching mindful parenting to parents, can be experienced. Basic knowledge and experience with MBSR and/or MBCT is expected.

Literature preparation (please read in advance):

Bögels, S.M., Lehtonen, A., & Restifo, K.(2010) Mindful parenting in mental health care. Mindfulness, 1, 107-120.

The book about this programme, Mindful parenting in mental health care, by Bögels & Restifo, will come out spring 2012 with Springer.

Short CV

Prof. Dr. Susan Bögels is a clinical psychologist and psychotherapist, specialized in Cognitive Behaviour Therapy for children and their families. She works as professor in developmental psychopatholoy at the University of Amsterdam and is the director of the academic treatment clinic for parents and children in Amsterdam. Her main research theme is the intergenerational transmission of anxiety disorders, and particularly the role of the father. Mindfulness for parents and children is another area of recent research interest. She has received several grants for RCTs on prevention and treatment programs for childhood anxiety disorders and other developmental psychopathology, and for implementation of these programs, as well as for fundamental research into the etiology of anxiety disorders. Recently she received a grant to study mindfulness in stressed pregnant women. She is a member of the workgroup anxiety disorders of the American Psychiatric Association preparing the DSM-V

Workshop 4: Trauma-focussed CBT for Traumatised Children and Young People

David Trickey

Lead Consultant Clinical Psychologist of an innovative service for traumatically bereaved children and young people in Luton and Bedfordshire, UK, an Approved NHS Provider.

The cognitive model of PTSD in children and young people (Meiser-Stedman 2002) will be presented and explained. This model will be used to consider: how children and families react to traumatic events, risk factors for PTSD, and how TF-CBT and related interventions decrease distress and increase functioning. Based on the notion of “processing”, ways in which a healing environment can be created around the child will be discussed, so that processing of the event is more likely to occur spontaneously. Direct intervention with the young person, with the family and with the school will be discussed and some time will be given to considering the difficulties associated with the fact that the intervention involves doing something that the client wishes to avoid. The evidence for TF-CBT and other interventions will be presented. The workshop will use a variety of training methods including interactive presentation of theory with case illustrations (with clients’ consent) and small group discussion

Learning Objectives

By the end of this workshop, the participants should:

  • Be familiar with and understand the cognitive model of PTSD
  • Be aware of how children and young people commonly react to traumatic events, (including the DSM-IV-TR diagnostic criteria of PTSD)and how the cognitive model can account for these reactions
  • Have some understanding of how developmental and systemic factors impact on such a model
  • Understand how to intervene effectively using TF-CBT taking into account developmental and systemic issues
  • Be familiar with the evidence supporting TF-CBT for children and young people with PTSD

Key References

MEISER-STEDMAN, R. (2002) Towards a Cognitive-Behavioral Model of PTSD in Children and Adolescents.Clinical Child & Family Psychology, 5, 217-232.

Biography of presenter

David has extensive clinical experience working with children and families, and since 2000 he has specialised in working with traumatised and traumatically bereaved children and young people. He worked for 6 years at the Traumatic Stress Clinic in North London, and was then Lead Consultant Clinical Psychologist at Leicester Royal Infirmary Children’s Hospital. He is now the Lead Consultant Clinical Psychologist of an innovative service for traumatically bereaved children and young people in Luton and Bedfordshire, UK, an Approved NHS Provider.

He acts as an Expert Witness or Advisor for the Courts, the Police and other organisations in relation to trauma and bereavement. He has particular expertise and experience of working with children who have witnessed one parent murdering another. He has been consulted following critical incidents to inform the crisis response. He was commissioned by the Department for Culture, Media and Sport to evaluate the Humanitarian Assistance Centre established in response to the London terrorist attacks on 7th July 2005.

He presents at small workshops and international conferences. He supervises and consults to other professionals, helping them to understand how traumatic events affect people, and what can be done to help. He contributes to the teaching and supervision for the CBT and IAPT courses for Children and Young People at UCL/Anna Freud Centre.

He supervises doctoral research relating to trauma and traumatic bereavement, publishes novel research and contributes to books.

Selected Publications

  • Trickey, D. (In press). Post-traumatic Stress Disorders. In P. Graham & S. Reynolds (Eds.) Cognitive Behavioural Therapy for Children and Families: 3rd Edition. CUP.
  • Trickey, D. et al. (2012). Meta-analysis of risk factors for PTSD in trauma exposed children. Clinical Psychology Review, 32, 122-138.
  • Trickey, D. & Black, D. (2009). Child trauma. In M. Gelder et al. (Eds.) New Oxford Textbook of Psychiatry. Second Edition. OUP.
  • Black, D. & Trickey, D. (2009). The effects of bereavement in childhood. In M. Gelder et al. (Eds.) New Oxford Textbook of Psychiatry. Second Edition. OUP.
  • Trickey, D. (2008). Experiencing refugee status after previous trauma. In P. Appleton (Ed.) Children’s Anxiety – A Contextual Approach.Routledge.

Workshop 5: Supervision of CBT with children, young people and families

Anne Stewart, Consultant Child and Adolescent Psychiatrist, Oxford City CAMHS, and CBT Trainer and Supervisor, Oxford Cognitive Therapy Centre.

Relevant Background: The expanding evidence base for the effectiveness of CBT for a wide range of child and adolescent mental health disorders has led to an increase in CBT training courses and workshops for Child and Adolescent Mental Health Services (CAMHS) professionals and development of CBT services within teams. The recent development of the CAMHS IAPT initiative has resulted in identification and training of supervisors in order to meet the needs of IAPT for children and young people. However, across the UK there is still a relative lack of trained supervisors in the CAMHS workforce. Benchmarking of CBT therapeutic and supervisory skills has recently been facilitated by the development of a competencies framework. The aim of this workshop is to support skills development of clinicians offering (or planning to offer) CBT supervision within CAMHS, with the wider aim of promoting dissemination of best practice in CBT in CAMHS.

Key Learning Objectives:

  1. To promote awareness of the supervision competences required in order to supervise CBT with children, young people and families
  2. To present a model of supervision in CAMHS which is informed by existing models and adapted for use within CAMHS
  3. To promote awareness of and support development of key supervisory skills, including specific CBT supervisory skills, modified where necessary for working with children and young people
  4. To provide an opportunity for participants to reflect on how CBT practice and supervision is supported within their own services and consider how this might be enhanced

Training Modalities: The workshop will offer a range of training modalities including small and large group discussion, interactive exercises, skills training and didactic presentation of material.

Key References:

  1. Stallard, P., Udwin, O., Goddard, M. & Hibbert, S. (2007). The availability of cognitive behaviour therapy in specialist child and adolescent mental health services (CAMHS): A national survey. Behavioural and Cognitive Psychotherapy, 35 (4), 501-505
  2. Townend, M. (2008). Clinical supervision in cognitive behavioural psychotherapy: development of a model through grounded theory. Journal of Psychiatric and Mental Health Nursing, 15, 328-339
  3. Kennerley, H and Clohessy, S. (2010) Becoming a supervisor. In M. Mueller, H. Kennerley, F. McManus and D. Westbrook (Eds.) Oxford Guide to surviving as a CBT therapist. Oxford University Press: Oxford.