May 23 – 25, 2011, Cognitive Behavior Therapy Workshop Level I: Depression and Anxiety

May 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, nurses and other professionals from mental health, medical, and related fields traveled from 16 states and 8 countries (including Brazil, Cayman  Islands, Denmark, Peru, Romania, Sweden, Switzerland, and Turkey) to attend this month’s Cognitive Behavior Therapy Workshop Level I on Depression and Anxiety at Beck Institute.

Participants had the opportunity to gain professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, observed and engaged in demonstration role-plays among other activities.

Cognitive Therapy Demonstration

Participants had the benefit of watching Dr. Aaron Beck conduct a live patient session, which was viewed via closed-circuit television. Following the patient interview Dr. Beck answered questions from participants in a case discussion (pictured above left), during which he explained what the next session should include. Dr. Beck explained agenda setting, beginning with a review of homework and went on to explain that he asks patients, “What problems do you want my help in solving today?” to guide them into naming the problems (as opposed to giving a full description at that moment), then prioritize the problems and let him know roughly about how much of the session they’d like to devote to each one. Participants noted some key techniques that Dr. Beck used which they found to be quite useful:

  • Normalizing patient’s emotions and beliefs
  • Providing patient with language with which they can describe and validate their thoughts
  • Instilling hope and reassuring successful treatment
  • Trying a variety of methods including imagery
  • Collaboration with the patient in terms of treatment model to prevent the patient from seeing the therapist as an authority figure
  • Finding some light anecdotes, humor can be a nice touch in sessions

Following the questions regarding the patient session, Dr. Beck answered participants’ questions on other subjects, such as Positive Psychology and CBT, and CBT with depressed patients in chronic pain. Dr. Judith Beck (pictured right) spoke about cognitive behavior therapy with depressed patients and their automatic thoughts.  She emphasized psychoeducation, treatment planning, goal setting, and activity scheduling with patients.  Dr. Leslie Sokol (pictured below) spoke about the need for anxiety and the need to learn how to control it, rather than mask it with medication.  She emphasized the use of Socratic questioning and interoseptive exposure experiments in treatment.  Dr. Norman Cotterell (pictured below) spoke about suicidality.

We are so pleased that so many professionals from all over the world were able to come to the Beck Institute for such an exciting workshop!

More event highlights:

Cost-Effectiveness and Clinical-Effectiveness of Combined Therapy versus Medication Only in Adolescents with Resistant Major Depression

Depression in adolescents is a significant issue. Research has focused on treating major depression in adolescents with psychotherapy (CBT), medication (selective serotonin reuptake inhibitors, SSRIs), or a combination of both.  As treatment is not inexpensive, researchers have been looking into the cost-effectiveness of different treatment models.  Previous research has shown that CBT treatment and medication is the most expensive treatment model in the short run.  The least expensive model is medication only.  However, some adolescents do not respond to medication alone.

A recent randomized trial was published in the Archives of General Psychiatry. 334 adolescents with SSRI-resistant depression, were randomly assigned to one of two groups for 24 weeks: a change in medication or a change in medication plus CBT.   Throughout the treatment they were assessed at 6, 12, and 24 weeks for symptom changes, depression-free days, and depression-improvement days.  The researchers also examined the clinical outcomes within certain subgroups of participants: patients with histories of abuse, comorbid disorders, and levels of hopelessness.

The study found that using a combined treatment of CBT and medication led to more depression-free and depression-improved days.  It worked best for patients without a history of abuse or with low levels of helplessness.  While the combined treatment was more costly in the short-run, it may be most cost-efficient in the long run.  This study demonstrates the benefits of further examining the use of combined treatment in adolescents with SSRI-Resistant Depression.

Lynch, F. L., Dickerson, J. F., Clarke, G., Vitiello, B., Porta, G., Wagner, K. D., … Brent, D.  (2011). Incremental cost-effectiveness of combined therapy vs medication only for youth with selective serotonin reuptake inhibitor – resistant depression.  Arch Gen Psychiatry, 68 (3), 253-262.

May 2 – 4, 2011, Cognitive Behavior Therapy Workshop Level II: Personality Disorders and Challenging Problems

Earlier this month, Beck Institute held the first Cognitive Behavior Therapy Workshop Level II: Personality Disorders and Challenging Problems.  In attendance were psychologists, psychiatrists, social workers, councilors, and other professionals from Brazil, Canada, Hong Kong, Sweden, Thailand, and nine U.S. states.  This higher level workshop provided extra training and guidance to professionals that wished to improve their abilities for the benefit of their clients.

Demonstration of Cognitive Behavioral Therapy Techniques

The workshop focused on the use of CBT for challenging problems, anger management, substance abuse, and Axis II disorders.  The Beck Institute faculty used role-plays and discussions to demonstrate the CBT techniques that would be useful with various patients. On day two, Dr. Aaron Beck spoke about research being done currently on the use of CBT with Schizophrenic patients.  Treatments are looking into the negative symptoms of patients and working with them to change their emotions regarding the hallucinations.  Random assignment of medication in Britain has shown that patients, who discontinue use of medication, still improve with CBT.  The workshop attendees were then able to see Dr. Aaron Beck use the techniques he pioneered in two role-plays.  Attendees brought real patient scenarios in front of the group in order to gain insight into treatment. The first role-play was about a lawyer in her late 30’s who went through a recent divorce.  She now has signs of depression, social anxiety, and OCD.  After the role-play, participants noted the following:

  • Dr. Beck followed a pattern of asking questions to elaborate on emotions and beliefs and then providing capsule summaries of the patient’s beliefs in an attempt to narrow in the focus of the problem.
  • Using mental rehearsal as an intervention, the patient would be able to see the rationality, or lack thereof, of her beliefs.
  • After focusing in on the problem, Dr. Beck analyzed the situation and assigned the patient homework (attending a party) that would push her anxieties.

The second role-play was about an unemployed man in his 40’s who has an unstable relationship, little friends, and constantly complains about the way he is treated.  This patient has a history of abuse and shows signs of social anxiety.  Attendees noted the following in Dr. Beck’s approach:

  • Dr. Beck focused on trying to conceptualize the patient’s views.
  • Using gentle interruptions and positive feedback, Dr. Beck was able to give the patient advice without looking like an authority figure.
  • The conversation was always pulled back into that which the patient had control over.

Participants received professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D.