Download Abstractbook EABCT 2012

EABCT
GENEVA 2012
42nd Annual Congress
August 29th - September 1st 2012
ABSTRACTS
Psychotherapy and
Neuroscience:
Evidence and
Challenges for CBT
www.eabct2012.org
Organizing Associations:
Table of Contents
Pre-Congress Workshops..................................... 3
In-Congress Workshops..................................... 15
Symposia............................................................ 25
Papers............................................................... 173
Posters.............................................................. 243
Author Index..................................................... 345
Pre-Congress
Workshops
PW-01
Pre-Congress
Workshops
Pratique de la psychologie positive dans les TCC
Christophe André1
1
SHU, Centre Hospitalier Sainte-Anne, Paris, France
Le courant de la « psychologie positive » est très actif
dans le monde actuel de la recherche en psychologie.
On y a dépassé le stade de la méthode de « Maîtrise
de soi-même par l’auto-suggestion consciente » du
pharmacien lorrain Émile Coué, à la fin du XIXe siècle,
ou le célèbre « Pouvoir de la Pensée Positive » de
l’américain Norman Vincent Peale, dans les années 50.
La psychologie positive est une réflexion scientifique sur
le fonctionnement humain optimal. C’est aussi une autre
façon de penser à l’amélioration du bien-être subjectif, en
se concentrant sur l’étude de ce qui construit notre santé,
et non plus seulement sur ce qui l’entrave. C’est, appliqué
à l’équilibre de notre esprit, la transposition du concept
de « santé active », qui s’impose désormais en médecine
: on peut contribuer à rester en bonne santé en adoptant
certains comportements (faire de l’exercice physique,
manger beaucoup de fruits et de légumes, éviter le tabac,
consommer l’alcool avec modération, etc.). De la même
manière, on peut augmenter ses chances de se sentir bien
mentalement en cultivant la gratitude ou la gentillesse, en
développant ses émotions positives, etc. L’atelier abordera
les données scientifiques actuelles en psychologie
positive, et proposera des exercices thérapeutiques à
prescrire aux patients.
Bibliographie :
Voir pour synthèse en matière de recherche en psychologie positive :
- Cottraux J. La force avec soi. Paris, Odile Jacob, 2007.
- Kahneman D, Diener E, Schwarz N (eds). Well-being, the foundations
of hedonic psychology. New York, Russell Sage Foundation, 1999.
- Lecomte J et coll. Introduction à la psychologie positive. Dunod,
2009.
- Snyder CR et Lopez SJ (eds). Handbook of positive psychology. New
York, Oxford University Press, 2002.
Du côté des ouvrages pour le grand public et les praticiens :
- André C. Les états d’âme : un apprentissage de la sérénité. Paris, Odile
Jacob, 2009.
- André C. Imparfaits, libres et heureux. Paris, Odile Jacob, 2006.
- André C. Vivre heureux. Paris, Odile Jacob, 2003.
- Ben Shahar T. L’apprentissage du bonheur. Paris, Belfond, 2007.
- Lecomte J. Donner un sens à sa vie. Odile Jacob, 2007.
PW-02
Why are the Emotions the Basis of Identity? A
post Rationalist Approach to Psychotherapy
Giampiero Arciero1
1
Institute of Constructivist Psychology and Psychotherapy,
Rome, Italy
4
The experience of Self is the starting point of our research.
Seeking to discuss the issue of the pre-reflective awareness
from a hermeneutics-phenomenological perspective we
address the question of emotions and personal identity
by focusing on the actual experience of living existence.
In this new light will develop the theme of identity as the
narrative reconfiguration of the experience.
PW-03
Schema Therapy for Borderline Personality
Disorder
Arnoud Arntz1
1
Maastricht University, The Netherlands
Borderline Personality Disorder (BPD) is one of the most
prevalent (1.5-2% in the general population) and severe
forms of psychopathology. BPD-patients are generally not
very popular among clinicians, and they often raise strong
countertransference feelings. One of the problems with BPD
is that these patients tend to suddenly change in emotional
state, confusing therapists and making them easily feeling
helpless and lost. Traditional CBT-approaches were not very
successful, missing a good understanding of the disorder.
Schema Therapy (ST) offers a model to understand BPD
and to apply specific methods and techniques depending
on the stage of therapy and the specific emotional state of
the patient. Briefly, BPD is understood as resulting from
problematic childhood experiences, characterized by
lack of safety and high threat levels. This includes unsafe
attachment and emotional (and often sexual) abuse. ST can
be seen as a way to repair these early experiences. ST has
3 foci: (1) the therapeutic relationship (the therapists offers
a safe relationship and “reparents” in a limited way); (2)
the past (traumatic experiences are processed, often using
experiental techniques like imagery rescripting); and (3) the
present (present problems are addressed). Emotional states
are understood by a schema-mode model, helping patients
to get grip on their emotions and therapists to choose the
right technique. Studies demonstrated that ST is a very
effective and cost-effective treatment, despite its length of
1.5-3 years.
Key Learning Objectives:
- to understand and apply the schema mode model of BPD,
so that BPD-symptoms and behaviours can be understood
- to be able to detect the mode the patient is in, and to
choose an appropriate technique
- to understand and apply the basic ST-techniques
- to use the therapeutic relationship to ‘reparent’
- to be able to choose focus and type of technique
according to the phase of therapy
Please note that for a full training a 4-days workshop is
recommended.
Training modalities (i.e. experiential, didactic, role play etc)
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Relevant books:
Arntz, A. & van Genderen, H. (2009). Schema Therapy for Borderline
Personality Disorder. Wiley.
Arntz, A. & Jacob, G. (2012). Schema Therapy in Practice. Wiley.
Farrell, J. & Shaw, I. (2012). Group schema Therapy for Borderline
Personality Disorder. Wiley.
Rafaeli, E., Bernstein, D. & Young, J. (2010). Schema Therapy.
Routledge.
Young, J.E., Klosko, J.S. & Weishaar, J.S. (2003). Schema Therapy, a
Practioner’s Guide. Guilford.
PW-04
An experiential guide to using Imagery in your
cognitive therapy practice
James Bennett-Levy1
1
Sydney University’s University Centre for Rural Health,
Australia
Integrating imagery effectively into CBT is one of the
new exciting frontiers of CBT. Although imagery made
occasional appearances in the behavioural and cognitive
behavioural literature from the 50s through to the 80s
(e.g. imaginal desensitization, imaginal flooding), until
this century it remained in the shadows of CBT - largely
unresearched, with few guidelines for how to use it in
clinical practice. Based on the recent book, The Oxford
Guide to Imagery in Cognitive Therapy (2011) by Ann
Hackmann, James Bennett-Levy & Emily Holmes, James
will provide a roadmap for using imagery in CBT practice.
The workshop will be practical and self-experiential. You
will have an opportunity to practice imagery interventions,
and experience them for yourself. You can expect to leave
with a clearer understanding of imagery’s use in CBT,
some helpful frameworks to conceptualise imagery-based
interventions, new skills, and enhanced confidence to use
imagery in their clinical practice.
PW-05
Coping-oriented couple therapy: Strenghthening
dyadic resources, intimacy and commitment
Guy Bodenmann1
1
University of Zurich, Switzerland
The workshop aims to introduce into the concept of dyadic
coping, its theoretical background and utility in working with
couples, either in the setting of prevention or couple therapy. First
findings on the impact of stress on relationship function and the
significance of dyadic coping as an option to deal together with
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stressful encounters are presented. In a second part, participants
learn about the concrete procedure and the 3-phase method for
enhancing dyadic coping is presented in role plays and trained.
The setting, the therapist’s behavior as well as the rationale of
the method are presented. The workshop aims to be practical
and to yield a more detailed insight in the way how one can
work with couples based on the dyadic coping approach for
enhancing mutual understanding of partner’s personality, trust
and intimacy. The coping-oriented couple therapy represents a
further development of cognitive-behavioral couple therapy and
helps therapists: (a) to present couples an understanding of how
external stress (e.g. work load) impinges on daily interactions of
partners and their relationship functioning (psycho-education),
(b) to work on couples’ self-disclosure related to stressful
situations (increase of mutual understanding for each partner’s
functioning in demanding situations) and (c) to foster dyadic
resources (mutual support provision) and the sense of “we-ness”
PW-06
CBT plus Interpersonal/Emotional Processing for
Generalised Anxiety Disorder
Tom Borkovec1
1
Penn State University, United States
Generalized anxiety disorder (GAD) is one of the most
common of anxiety disorders, both as a principal and as
an additional diagnosis. Some have argued that it is the
basic anxiety disorder from which the others often emerge.
Despite its prevalence and importance, fewer therapeutic
developments specific to this disorder have been made
relative to most of the other anxiety disorders. The first
portion of this workshop will provide clinical training
in several cognitive behavioral techniques for GAD that
have been developed from our clinical and experimental
experience with the disorder over the past 20 years: (a) selfmonitoring of anxiety process and the learning to detect
early anxiety cues; (b) flexible deployment of multiple
applied relaxation methods; (c) in-session imaginal
rehearsal of coping responses; (d) multiple cognitive
techniques to facilitate more flexible and adaptive ways of
perceiving, the emergence of “expectancy-free” cognitive
styles, and the processing of present-moment experience.
The second portion is designed to introduce the use of
interpersonal and experiential techniques (IEP). This
portion will present: (a) the main underlying assumptions
and features of IEP, (b) the general and specific techniques
for intervening at the interpersonal and emotional levels,
and (c) how the therapeutic relationship can be employed
to facilitate intrapersonal and interpersonal functioning.
A video-tape of an IEP session with a GAD client that
demonstrates many of the interpersonal and experiential
techniques and that resulted in a dramatic change for
the client and her anxiety will be shown. Throughout the
5
Pre-Congress
Workshops
1. Didactic power point presentation
2. Modeling techniques (DVD, life role play)
3. Experiental: practice in pairs
4. Questions and discussion
workshop, empirical information will be provided to give
strong foundation for the particular recommendations of
specific technique applications for GAD and for possible
future developments in its treatment.
Pre-Congress
Workshops
PW-07
An introduction to Compassion Focused Therapy
Paul Gilbert1
1
University of Derby, United Kingdom
This workshop will introduce people to the basic model of
compassion focused therapy (CFT). CFT began with the
problem of people saying they could understand the logic
of cognitive therapy but even with changing their thoughts
struggled to feel different. CFT is an evolution based model
of psychopathology and is focused on the emotional
systems that give rise to the feelings of reassurance
and affect change. These are primarily affiliative-based
systems. Participants will learn about the link between
affiliative emotion, cognitive and behavioural change, and
how shame and self-criticism blocks this emotion system.
The first part of the workshop will cover the basic concepts
with PowerPoint presentations and video displays. The
second part of the workshop will provide some experiential
opportunities to practice some of the imagery, behavioural
and meditation exercises
By the end of the workshop participants will have
• an overview of the evolutionary model that underpins
CFT
• insight into the three types of affect regulation system
• understanding the role of attachment mechanisms in
our affect change
• insight into the CFT model of compassion which is
based on two different psychologies:1 capacities for
engagement with suffering and 2. abilities to alleviate it
some experience of core CFT exercises
PW-08
Integration emotionfokussierter Techniken in die
kognitive Verhaltenstherapie gegen Depressionen
Martin Grosse Holtforth1
1
University of Zurich, Switzerland
Emotional processing is considered a central mechanism
of change across psychotherapy approaches. However in
cognitive-behavioral therapy, emotional processing has
rarely been targeted by specific interventions. To foster
emotional processing in the cognitive-behavioral therapy
of depression, Exposure-Cased Cognitive Therapy (EBCT)
has been developed by integrating emotion-focused and
mindfulness-based interventions within an exposure6
based framework. The workshop will provide an overview
of EBCT and illustrate the manualized treatment using
clinical examples (workshop in German).
PW-09
Mindfulness in medicine and psychology - A firsthand taste and clinical applications
Jon Kabat-Zinn1
1
University of Massachusetts Medical School, Boston,
United States
This workshop will be primarily experiential, serving as an
introduction to the meditative practices associated with MBSR
(mindfulness-based stress reduction) and MBCT (mindfulnessbased cognitive therapy). Direct first-person engagement is
essential for understanding the heart of any clinical approach
making use of mindfulness training. Mindfulness is a rigorous
meditative discipline. It has its own profound framework for
investigating, understanding and working with: (1) the nature
of the mind; (2) inner and outer relationships mediated by the
senses (including the capacity for awareness); (3) destructive
emotions and intrusive thoughts; (4) body sensations including
pain; and (5) mental and physical suffering. Mindfulness is a
gentle, self-compassionate, but also challenging way of being
and perceiving and inhabiting one’s life. It is not a cognitive/
behavioral technique, deployed in particular circumstances as
required, but rather a way of being different from the normal
“doing” mode of mind. We will practice some aspects of MBSR
together, space and time permitting, such as sitting meditation,
the body scan, and mindful yoga, and well as mindful eating and
mindful walking. We will also explore in group dialogue and
inquiry the experiential dimension of what actually arises for us
during formal mindfulness practice, with an eye to its potential
applications both in one’s personal life, and in professional
clinical situations in medicine and psychology.
During the course of the workshop, Dr. Kabat-Zinn
weave in comments related to the clinical applications of
mindfulness through MBSR and MBCT and explore various
models that have been used to interpret its positive effects
on quality of life and health, including how it influences
depressive rumination. Time permitting, he may touch on
relevant aspects of the history, rationale, structure, and
protocols of MBSR and MBCT, and various neurocscience
and clinical outcomes. However the majority of the
conceptual framework will be in his Keynote Address and
not in this experiential workshop. This division of labor will
give workshop participants sufficient time to experience
and report on their firsthand encounters with the practice
of mindfulness. There will be ample time for questions.
Learning Objectives:
1. Name and describe the major formal and informal
meditation practices associated with
MBSR and their various attributes and value.
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Key references:
Kabat-Zinn, J. (2005) Coming to Our Senses, Hyperion, NY.
Kabat-Zinn, J. (1990) Full Catastrophe Living Dell, NY.
Kabat-Zinn, J. (2003) Mindfulness-Based Interventions in Context:
Past, Present, and Future. Clinical Psychology Science and Practice,
10, 144-156.
Hölzel B.K., Carmody,J, Evans, K.C. et al (2009). Stress reduction
correlates with structural changes in the amygdala. Social Cognitive
and Affective Neuroscience Advance Access, September 23.
PW-10
Cognitive-Behavioral Therapy for insomnia and
Related Sleep Disorders
Charles Morin1
1
Université Laval,Quebec, Canada
Insomnia is a prevalent complaint either as an
independent disorder or as a condition comorbid with
other psychological or medical disorders. Although
medication is the most frequently used treatment for
sleep disturbances, cognitive-behavioral therapy (CBT)
is increasingly recognized as the treatment of choice
for chronic insomnia. The purpose of this workshop is
to describe state-of-the-art CBT for insomnia, review
innovative methods for optimizing its implementation,
and summarize the evidence regarding its effectiveness.
The main emphasis will be on insomnia, although other
less common sleep disorders (e.g., nightmares in PTSD)
will be discussed as well. The first part of the workshop
will present a brief overview of normal sleep, describe
clinical/diagnostic features of insomnia and other major
sleep disorders, and present a typical assessment
protocol for evaluating sleep complaints. The second part
of the workshop will focus on insomnia treatment, with a
primary emphasis on CBT. Empirically-validated therapies
will be described and clinical case examples will be used
to illustrate their applications. Practical guidelines for
the management of insomnia in special populations
(e.g., elderly) and in patients with comorbid medical or
psychiatric disorders will be described. Sleep medications
commonly prescribed for insomnia will be reviewed and a
systematic discontinuation program will be presented to
assist those with hypnotic-dependent insomnia. Clinical
and practical issues regarding the implementation of a
CBT protocol for insomnia will be discussed.
Learning objectives:
• Recognize clinical features of insomnia and other sleep
disorders
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• Identify the main differential diagnostic issues
• Learn key questions for assessing sleep-related
complaints
• Gain knowledge about cognitive-behavioral interventions
for insomnia
• Refine clinical skills for treating insomnia comorbid
with other medical or psychiatric disorders
PW-11
Incorporating Strengths into Collaborative Case
Conceptualization to build Resilience
Christine Padesky1
1
Center of Cognitive Therapy, Newport Beach/Huntington
Beach, California, USA
A recent new approach to CBT case conceptualization
(Kuyken, Padesky, & Dudley, 2009) offers a step-bystep model to guide therapists’ treatment planning with
complex cases, especially when no single treatment
model applies. This approach incorporates three guiding
principles: (1) collaborative empiricism, (2) three levels of
conceptualization that evolve over the course of therapy,
and (3) incorporation of client strengths into each level of
conceptualization so therapy is designed to both relieve
distress and build resilience.
While this workshop demonstrates all three principles,
there is an emphasis on incorporation of client strengths
into case conceptualization. Dr. Padesky models how to
incorporate client culture, personal interests, imagery, and
metaphors into constructive, strengths-based conceptual
models. In addition to the opportunity to participate in
structured exercises designed to develop relevant skills,
participants explore the implications of explicitly adding
a strengths and resilience focus to CBT conceptualization
and treatment.
Learning objectives
• Differentiate between three levels of case
conceptualization
• Improve your awareness of how to search for “hidden”
client strengths
• Practice methods to bring strengths into client awareness
• Collaborative with your clients to construct
conceptualizations that incorporate strengths as well as
vulnerabilities
• Explore the added value of identifying client-generated
metaphors and imagery
References:
Kuyken, W., Padesky, C. A., & Dudley, R. (2009). Collaborative case
conceptualization: Working effectively with clients in cognitivebehavioral therapy. New York: Guilford.
Padesky, C. A. & Mooney, K.A. (2012). Strengths-based CognitiveBehavioural Therapy: A four-step model to build resilience. Clinical
Psychology & Psychotherapy, 19 (4), 283-90.
7
Pre-Congress
Workshops
2. Examine the challenges of mindfulness practices and
their potential promise.
3. Assess the challenges of adopting mindfulness as a
discipline in one’s own life, and in
the lives of one’s patients.
Training Modalities: 80% experiential; 20% didactic
PW-12
Modular CBT for depressed adolescents
Mark Reinecke1
1
Northwestern University, Chicago, United States
Pre-Congress
Workshops
Adolescent depression is an important clinical and
public health problem. The disorder is common, with a
prevalence rate of approximately 5-8%. It is associated
with social and academic impairment, family burden, and
an increased risk of alcohol abuse, substance abuse, and
suicide. Moreover, it places youth at risk for recurrent
major depression during adulthood and for long-term
psychosocial impairment. Of particular concern are recent
findings indicating that rates of completed suicide among
children and adolescents in the United States rose 18%
between 2003 and 2004.
Data from the Treatment of Adolescents with Depression
Study (TADS, SOFTADS), a multi-site, randomized,
controlled outcome study of 439 patients between 12
and 17 years of age with a primary diagnosis of major
depression, indicates that Cognitive-Behavioral Therapy
(CBT), medication management with fluoxetine, and a
combination of fluoxetine with CBT can be effective for
treating depression among adolescents. The combination
of fluoxetine and CBT appears to be most effective for the
acute treatment of major depression among adolescents,
and is associated with significant improvement in
psychosocial functioning and reductions in suicidal
ideations. CBT appears to be more effective than fluoxetine
alone for alleviating suicidality, and may offer a protective
effect for depressed youth who receive fluoxetine. Recent
evidence indicates that clinical gains for fluoxetine, CBT,
and a combination of fluoxetine and CBT are maintained
over a 52 week follow-up period.
In this workshop we will review the CBT treatment protocol
developed for the Treatment for Adolescents with Depression
Study, and will discuss how it can be employed in clinical
practice. We will begin with a brief review of the etiology,
clinical presentation, and diagnosis of pediatric depression,
and will discuss useful diagnostic and assessment
instruments. We will then present the TADS CBT case
formulation and treatment program. We will briefly discuss
the integrative “socio-cognitive” model for depression which
served as a foundation for the CBT protocol, and how the
“modular” CBT protocol can be modified to address specific
cognitive, behavioral, and affective deficits that maintain the
adolescent’s depression. We will conclude with a discussion
of findings from the TADS project regarding the efficacy of
CBT, predictors and moderators of acute treatment response,
functional improvement, suicide, and maintenance of gains
over time. Given current rates of suicide among youth, the
importance of improving access to empirically-supported
treatments for depression—including CBT—will be
emphasized.
8
Format:
Teaching materials will include a set of Power Point slides, and copies
of empirical, conceptual, and clinical papers derived from the TADS
project. Each participant will receive a set of 4-5 papers and chapters.
The material will presented in a workshop format. We would begin by
providing a brief overview of pediatric depression and a summary of the
design of the TADS project. We will then discuss the socio-cognitive
model of depression and review the CBT protocol. We would conclude
with a brief review of empirical findings from the study and a discussion
of their clinical, research, and public policy implications. Our approach
would be practical--We would discuss the various cognitive models of
depression that inform CBT case formulation and would review specific
treatment strategies and techniques in some detail.
PW-13
Motivation and change: CBT applied to addiction
Frank Ryan1
1
The Margarete Centre, London, United Kingdom
Cognitive neuroscience research has generated profound
insights into the mechanisms of addiction. In particular,
findings have revealed how compulsive habits can proceed
automatically with little if any insight and independently of
explicit intentions to change. While this definitive feature
of habitual behaviour can remain latent in the clinic, it can
lead to treatment setbacks and ultimately relapse between
sessions or at follow-up. The Workshop aims to teach
participants how to translate and integrate these insights to
boost motivation and improve self-regulation with clients
who present with substance misuse and allied mental
health problems. The workshop should be relevant to both
specialist substance misuse practitioners as well as those
who encounter drug and alcohol problems in generic
mental health or primary care settings. The framework,
termed CHANGE (Change Habits and Negative Generation
of Emotion), places the development of impulse control or
habit management strategies at the centre of the therapeutic
intervention. Accordingly, interventions that augment
cognitive control processes such as selective attention
and working memory are likely to enhance outcomes. The
programme is organised into four sequential stages known
as the “Four M s”:
• Motivation and engagement;
• Manage impulses and craving;
• Mood management;
• Maintenance and relapse prevention
Each of these stages requires tailored intervention
strategies reliant on the therapist deploying specific
competencies. Throughout, particular emphasis is placed
on the importance of a robust therapeutic alliance based
on a clear conceptualisation of the psychology of addictive
behaviour drawing on both tried and tested and emergent
cognitive neuroscience paradigms. The content will involve
didactic presentation and an opportunity to observe and
practice relevant skills. Participants should learn:
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PW-14
La Psychothérapie Comportementale et Cognitive
du Deuil Compliqué
Alain Sauteraud1
1
Medical Private Office, Bordeaux, France
Le deuil est reconnu depuis peu comme pouvant générer
une pathologie mentale appelée communément deuil
compliqué, deuil prolongé mais aussi deuil pathologique.
Selon ces critères, 11% des endeuillés souffriraient de
deuil compliqué et 1 à 4% de la population générale.
Le deuil compliqué se caractérise par une douloureuse
nostalgie pour le défunt qui manque cruellement à
l’endeuillé. Cet état de manque du défunt est spécifique
du deuil compliqué mais s’y ajoutent des symptômes
d’état de stress post-traumatique et d’épisode dépressif.
Aucun symptôme n’est suffisant pour distinguer le deuil
compliqué du deuil normal, seules l’intensité et la durée
sont anormales dans le deuil compliqué.
Le deuil compliqué a fait l’objet de peu d’étudeJ de
psychothérapie et est réputé faiblement réagir aux
médicaments. Les thérapies comportementales et cognitives
(TCe) sont les plus validées scientifiquement. L’analyse
fonctionnelle en thérapie comportementale et cognitive
est très propice à la compréhension du deuil compliqué.
De cette analyse découlent des méthodes thérapeutiques
assez typiquement comportementale (exposition graduée)
et cognitive (remise en question socratique des croyances
stéréotypées). L’intégration à la TCC du modèle de
l’attachement issu des travaux de Bowlby et de ses
successeurs permet d’aborder le symptôme spécifique au
deuil qu’est le manque du défunt.
L’atelier exposera la clinique du deuil normal et pathologique,
l’analyse fonctionnelle comportementale et cognitive du
deuil pathologique et l’exposé des prises en charge en
psychothérapie comportementale et cognitive. Des exposés
de cas cliniques dont l’un en vidéo viendront étayer le cours.
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PW-15
Introduction to ACT: A transdiagnostic behavioural
treatment
Rainer Sonntag1
1
Behavioral Psychiatrist in Private Practice, Olpe, Germany
Acceptance and commitment therapy (ACT, spoken as
a single word) is a transdiagnostic, process-oriented
treatment within the CBT family. Based on an explicit
philosophical background and a profound experimental
and applied research program this treatment approach has
been developed for about 30 years. It has been successfully
applied to a diverse array of mental and some somatic
(e.g. epilepsy, diabetes) disorders in different practice
settings. Instead of trying to reduce symptoms or change
cognitive or emotional content ACT is concerned with
helping people to engage in valued activities even in the
midst of psychological pain and other difficult emotional
experiences. The workshop introduces the basic model
and presents some specific therapeutic interventions that
can help to better accept emotions, defuse from cognitive
content, strengthen contact to the present moment and
to a resilient sense of self, choose values, and engage in
preferred activities rather than to struggle with thoughts and
escape from or avoid emotions, memories, or other difficult
experiences. The overarching goal is to fluidify congealed
behavior patterns and facilitate flexible behavior according
to one’s goals and values. Interventions will be practiced that
can be used with existing therapeutic repertoires or may be
a starting point for developing further ACT competencies.
PW-16
Using psycho-education with resistant bipolar
disorders
Francesc Colom1; Jean-Michel Aubry2
1
Hospital Clinic University of Barcelona, Spain; 2Hôpitaux
Universitaires de Genève, Switzerland
Bipolar disorder is a chronic, severe illness with high
rates of relapse, high suicide rates and a remarkable
psychosocial burden. Despite the existence of well-tested
newer drugs that, together with clasic mood-stabilizers
constitute quite a large number of pharmacological
treatment options, bipolar patients are symptomatic
for almost half their lives. This might be due to several
accompaning features of bipolar disorders, including poor
pharmacological adherence, unhealthy habits and lack of
illness insight. This is why pharmacological treatment,
although is essential, may not be enough for most patients.
Thus, complementary interventions are needed to reach
syndromal and functional recovery.
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Pre-Congress
Workshops
• How to conceptualise complex cases involving
substance misuse and co-occurring disorders
• An integrated approach to assessment and intervention
with addictive disorders and co-occurring problems;
• Strategies designed to enhance motivation and
commitment to therapy and reduce non-compliance;
• Techniques designed to help clients overcome
information processing biases and impaired impulse
control;
• Key outcome variables and how to measure them.
The theoretical and research background will be described
in a forthcoming book by the workshop presenter and
available for pre-order:
Cognitive Therapy for Addiction: Motivation and Change
Wiley Blackwell.
Pre-Congress
Workshops
Psycoeducation, a user-friendly, common sense-based
psychosocial strategy, has shown to prevent all sort of
relapses at 5-year follow-up and to be efficacious even
with fully adherent patients, so the effect does not relay
completely on adherence enhancement. The content of
the Barcelona Psychoeducation Program focuses on the
illness, its causes and its consequences rather than on
other issues such as personality, psychodynamic features
and so forth. Topics are divided in five main areas:
• Illness insight
• Adherence enhancement
• Early detection of prodromal symptoms and early
intervention
• The importance of avoiding street drugs
• Routines and stress management
The present workshop will shortly introduce rationale, tools
and techniques and efficacy results of psychoeducation for
bipolar patients, inviting the attendees to participate with
their clinical experience on the issue.
The structure of the workshop is as follows:
1. Introduction: What’s the need for psychotherapy in
bipolar disorders?
2. Tested psychological interventions for bipolar disorders:
state of the art
3. Psychoeducation: basics and principles
4. Psychoeducation: practical setting. When? Who? How?
What?
5. Illness insight. Role playing and practical exercises
6. Adherence improvement. Impact of non-adherence.
Causes and consequences of non-adherence. How to
measure non-adherence in research and clinical practice.
Coping with non-adherence in psychoeducation
7. Early warning-signs identification. Practical cases.
8. Improving habits (substance use and lifestyle) by means
of psychoeducation.
9. Efficacy of psychoeducation
10. The limits of psychological therapies in bipolar disorders
PW-18
CBT for working with people who have persistent
pain
Helen McDonald1
1
University of Sheffield, United Kingdom
Persistent pain is one of the key reasons for long term
ill-health and disability in Europe. Chronic pain can lead
to limitations and misery not only for the person living
with pain, but also for those close to them, with social,
financial and wider implications. The workshop aims to
give an interactive and practical introduction to working
with people who have persistent pain. CBT will be used
in the context of a bio-psycho-social approach to pain
management. There will be a brief overview of chronic
pain and its impact, and an outline of the evidence base
for using CBT to help people who have persistent pain.
Particpants will take part in experiential exercises, case
examples, discussion and role plays in order to enhance
knowledge and practice relevant skills.
PW-17
PW- 19
Keeping supervision on track: Managing
competing tensions
Mark Freeston1
1
Newcastle University, United Kingdom
Supervision is a highly valued part of the development
and maintenance of therapeutic skill, a keystone in clinical
governance by contributing to the delivery of safe and
ethical practice, and appreciated by therapists for the
support it provides in what is often challenging case
work. With a wide range of competing potential tasks that
could be considered in what is typically a small amount of
time, it is essential to use the time effectively. Getting the
balance right requires an awareness by both supervisor
A mindfulness and CBT integrate treatment for
psychoses: how to improve the quality of life from
the early onset to chronicity
Antonio Pinto1
1
Centro di Psicoterapia cognitivo-comportamantale,
Naples, Italy
10
and supervisee. When supervision is delivered in a group
setting, then the additional numbers of people in the
room, often reduced time per supervisee, the variability
between the supervisees and the interactions between
them increases the complexity and the challenge for all
participants. Our experience with developing supervision
models and training over the last ten years has enabled us
to identify some key guiding principles that can be applied
across a range of supervisory settings and formats.
The workshop will consider guiding principles in three
key areas of supervision. 1) Setting up more effective
supervision; 2) Different and complementary supervisory
styles; 3) Ways to recognizing when core supervisory
functions are under threat and potential ways of getting
effective supervision back on track.
One psychosocial approach that may prove effective in the
long- term management of schizophrenia is CognitiveBehavioral Therapy . It is now evidence based that CBT leads
to a better improvement in the overall symptomatology, mainly
due to the effects on the positive symptoms. Despite there has
been evidences for the effectiveness of CBT for psychosis, not
all patients succeed in applying CBT techniques.
EABCT 2012
PW-20
Increasing positive emotion among children in
therapy
Tammie Ronen1
1
Tel-Aviv University, Israel
The last decade has seen an increased interest in the role
of emotions in general, and the ability to express positive
emotion, in particular.
With children, these aims are even more important due to
the developmental characteristics of emotion.
The workshop combines three parts:
First, there will be a short presentation of the basic
components of positive psychology: subjective well being,
positive affect, happiness and satisfaction of life and its
importance in helping children flourishing.
Second, there will be presentation of the developmental
nature of emotion, which necessitate going through the
5 basic steps : expressing emotion, identifying emotion,
accepting emotion in the self and others, understanding
EABCT 2012
emotion and controlling emotion, in order of helping
children enhance positive emotion.
Third, the workshop will focus on creative innovative ways
to increase positive emotion among children in therapy
using verbal group therapy, as well as non verbal modes
such as sport and music. Three main projects will be
presented with demonstrations and illustration of the way
children express positive and negative emotions
PW-21
A cognitive behavioral approach in binge eating
disorder and obesity
Johan Vanderlinden1
1
University Psychiatric Center Kuleuven Campus
Kortenberg, Belgium
A manualised CBT program for the treatment of patients with
obesity and binge eating disorder will be presented. The
program runs one day a week during a 24 week period. It is
aimed for both men and women with binge eating disorder
often in combination with obesity. The program consists of
well structured group therapeutic sessions and focuses on
the following therapeutic goals: (1) psycho education with
regard to the risks of obesity and binge eating, (2) learning
new and healthy eating behaviours while promoting an
active life style, (3) becoming aware of the different triggers
of binge eating and learning alternatives to deal with
these difficult situations; (4) installing a functional selfevaluation system; (5) improving self-esteem; (6) dealing
with /tolerating of emotions by means of heart coherence
training; and (7) preventing relapse. Loss of weight is not a
primary goal. The main focus is on improving the general
well-being and quality of life of the patients.
At the end, results of a prospective study without a control
group consisting of three measurements (a baseline
measurement and 2 FU assessments up to 5 years after
the start of the CBT treatment) of this program will be
presented. Our data show that a CBT approach offered 1
day a week during on average 7 months, produces benefits
on both eating behaviours, weight and psychological
parameters, that are durable up to 5 years post-treatment!
References:
Vanderlinden, J., Dalle Grave, R., Fernandez, F., Vandereycken, W. &
Pieters, G. (2004). Which factors do provoke binge eating in eating
disorders?. Eating and Weight Disorders, 9, 300-306.
Vanderlinden, J, Adriaensen, A., Vancampfort, D., Pieters, G. Probst,
M., & Vansteelandt, K. (2012). A cognitive-behavioural therapeutic
program for patients with obesity and binge eating disorder: short- and
long term follow-up data of a prospective study. Behaviour Modification
(in press).
11
Pre-Congress
Workshops
In the last years, mindfulness significantly contributed to
promote the ultimate goal of all medical and psychological
treatments: easing patients’ suffering (Segal et al., 2002).
One of the goals of a mindfulness-based therapy is having
patients see how their suffering and discomfort do not
come from the symptoms themselves, but from how they
react to them and what they decide to do (or not) in order
to try and overcome or suppress them.
Therefore this workshop aims at presenting the model of a
structured intervention, whose first goal is to create a solid
therapeutic alliance with the client. The acceptance of
the issues presented by the client and the search for a
meaning in the delusion must be presented as essential
milestones in the process of gaining the client’s trust.
A second stage in the therapy will focus on building with
the client a shared model of the disorder.
The third stage will focus on identifying the coping
strategies spontaneously adopted by the client. In this
respect, the client will be provided with strategies, aimed
at achieving a better coping with hallucinatory experiences
and, therefore, a better management thereof.
The mindfulness contribution could help to develop the
necessary skills to be less reactive to what is occurring at
the moment, allowing patients to deal better with different
types of experiences (Germer, 2005).
Finally, the latest cognitive and behavioral techniques will
be used to change the perspective on the content of the
delusional ideas.
The course will provide explanations on the ways to provide
the client and his/her family with psychoeducational tools
in order to learn how to prevent relapses and promptly
identify the signs of a crisis.
PW-22
Pre-Congress
Workshops
Introduction to CBASP, an integrative treatment
for resistant depression
Martina Belz1
1
University of Bern, Switzerland
The Cognitive Behavioral Analysis System of
Psychotherapy (CBASP) model was developed specifically
for the treatment of early-onset Chronic Depression
Disorder (APA, DSM-V, in press), one of the most difficult
outpatients practitioners treat.
The therapy system synthesizes the theoretical writings
of several psychologists: Seligman, Bandura, Piaget,
Pavlow, Skinner and Kiesler. These variegated ideas and
assumptions about early development, behavior, and
behavior change have been synthesized by McCullough
(2000) and provide the theoretical foundations for CBASP.
Frequently, the chronic depression course begins
during early adolescence with a diagnosis of Dysthymia
(signaling a tumultuous developmental history). One or
more episodes of Major Depression likely characterize
the course. The early-onset patient frequently reports
a history of (a) Psychological Insults (verbal assaults,
emotional deprivation, or physical punishments) and/or
a history of (b) Trauma (rape, sexual abuse or periodic
physical assaults where injury results). Based on six basic
assumptions of the
CBASP Model I will show what must be accomplished
in psychotherapy so that chronic depression can be
effectively managed if patients are willing to learn the
lessons of treatment.
1) Participants will become familiar with the basic
assumptions of the CBASP Model
2) Participants will see how two techniques of CBASP
(Situational Analysis; Interpersonal Discrimination
Exercise) are used to address the two basic learning goals
od the CBASP Model
3) Participants will become familiar with the rationale
for using Disciplined Personal Involvement (DPI)
and understand how the DPI role of the therapist is
administered.
PW-23
Emotion-Focused Cognitive Therapy
Mike Power1
1
Edinburgh University, United Kingdom
This workshop will be based on the book EmotionFocused Cognitive Therapy (2010). A brief overview will
be offered of the theoretical model known as SPAARS.
However, most of the workshop will be based on the ways
12
in which emotion can be assessed in therapy, how an
emotion-focus can be chosen, and ways of working with
different types of emotional problems. Clinical examples
from a range of disorders will be used throughout the
workshop in illustration of the basic priciples of working
with an emotion focus.
PW-24
Working with Intrusive Memories in PTSD: The
Ehlers and Clark Approach
Ann Hackmann1
1
Oxford Mindfulness Centre, University of Oxford, and
Oxford Cognitive Therapy Centre, United Kingdom
In this workshop the Ehlers and Clark model of PTSD
will be briefly presented. This recent model highlights
the central features of trauma memory, including intrusive
images, affect without recollection, and the sense of
current threat arising from the lack of time code and
contextual information, as well as from idiosyncratic,
distorted meanings that were given to the worst moments
of the trauma . Maintenance aspects are also highlighted.
From these observations a set of interventions have been
derived. These will be illustrated with case examples and
DVD clips. There will be opportunities to practice and
discuss treatment techniques including micro-fomulation
of hotspots, reliving to elaborate the memory, verbal
and bodily updating of hotspots, imagery rescripting of
hotspots, work with earlier memories that coloured the
event, site visits, stimulus discrimination and behavioural
experiments.
A reference list and outcome data will be provided.
PW-25
Mindful parenting in mental health care
Susan Bögels1
1
University of Amsterdam, The Netherlands
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
EABCT 2012
helpful in teaching mindful parenting to parents, can be
experienced. Basic knowledge and experience with MBSR
or MBCT is expected.
Pre-Congress
Workshops
PW-26
How to regain control in eating disorder patients
with a history of psychotrauma? A cognitive
behavioral approach
Johan Vanderlinden1
1
University Psychiatric Center Kuleuven Campus
Kortenberg, Belgium
In this workshop some basic guidelines in the treatment
of traumatized eating disorder patients, often showing a
great comorbidity, dissociative symptoms and impulse
dyscontrol, will be presented.
In the first part we focus on the topic how trauma
experiences, eating disorder symptoms and impulse
dyscontrol problems are related to one another and which
factors may mediate the trauma-ED link.
In the second part the most important goal in the first phase
of treatment, i.e. how to regain control over impulsive
and self-destructive behaviours, will be outlined. Several
therapeutic techniques (such as heart coherence training,
self-hypnosis, guided imagination, writing assignments,
EMDR) will be proposed –by means also of DVD
demonstration- that can help ED patients with a history of
(mostly emotional) trauma to rewrite their personal trauma
history and to deal more effectively with the aftermath of
trauma and the maladaptive behaviours that disrupt their
lifes.
EABCT 2012
13
In-Congress
Workshops
IN-Congress
Workshops
IW 01
IW 02
Understanding Complex Problems: The
Case Formulation Approach in CBT– Part
1: The pioneering model and current
status
Michael Bruch1
1
University College London and London Metropolitan
University, UK
Background: The case formulation approach is an
individualised assessment treatment procedure guided
by clinical-experimental methodology and cognitivebehavioural principles. The main goal is to develop
a problem formulation to explain development and
maintenance of problem behaviours, to suggest an
intervention hypothesis, to facilitate suitable evaluation
methods and to guide development of tailor made
intervention programmes. This model was originally
inspired by HJ Eysenck and pioneered by Vic Meyer in
the context of complex psychiatric disorders, such as
personality disorders. The approach can be contrasted
to the so called ‘technique-symptom matching’ practice
in CBT which has been shown to be inappropriate and
limited for real problems in the real world.
Key Learning objectives: This workshop will present the
current status of the UCL case formulation model and is
suitable for all levels of experience in CBT. It is especially
recommended for beginners who are keen to understand
the application of basic methodology underlying a learning
based therapeutic approach. Participants should have a
basic knowledge of learning principles, cognitive theories
and experimental methodology.
The workshop will offer a step by step guide
covering the following areas:
• How to structure and conduct the Initial Interview,
• How to selecting options for a multilevel analysis,
• How to develop a formulation of problem(s) and
intervention hypothesis
• How to develop a formulation guided therapeutic
relationship,
• How to construct and implement Intervention /
Evaluation Strategies.
• Clinical examples will be provided and participants are
encouraged to present own cases for discussion.
Training modalities: Teaching methods employed
will be both didactic (powerpoint/overhead/video) and
experiential (role plays/presentation). This shall be
adjusted to preferences and experiences of participants.
La TCC pour faire la paix avec la
nourriture et l’image de soi
Laurence Collet-Roth1
1
Private Practice, Lyon, France
Combat dans l’assiette, luttes émotionnelles, tyrannie du
paraitre, peut-on donner des outils à nos patients pour ne
pas être dans le contrôle ou dans la perte de contrôle...?
L’insatisfaction corporelle et la stigmatisation du gras et du
gros induisent un ébranlement de la vision de soi et une
estime de soi fortement diminuée.
Dans le défi de l’acceptation de soi dans notre culture
de perfectionnisme, l’objectif thérapeutique est de
comprendre les cercles vicieux qui mènent vers les
privations, restrictions, compensations, pertes de
sensations et troubles émotionnels
Comment aider nos patients à choisir ou construire des
facteurs de protection et des sources de renforcement pour
améliorer leur bien-être subjectif?
Comment établir des cercles plus vertueux ou
l’apprentissage de la valorisation de soi même et le lâcher
prise pourraient être un but thérapeutique?
A l’aide d’outils de pratique clinique et de techniques
expérientielles nous nous exposerons à l’acceptance de
l’image corporelle.
En espérant ainsi pouvoir mieux proposer à nos patients à
établir «une santé active» ET «une beauté active»....
References:
Bruch, M H & Bond, F W (1998) Beyond Diagnosis: CognitiveBehavioural Case Formulation. Chichester: Wiley.
Nikcevic, A V; Kuczmiercyk, A R & Bruch , M H (2006) Formulation
and Treatment in Clinical Health Psychology: Brunner-Routledge
16
IW 03
School Resilience Program – From
Crisis to Growth Prevention of PTSD and
building life skills Mindfulness
Daniel Hamiel1
1
Tel-Aviv University Medical School, Israel
The workshop is based on a school resilience program
aimed to prepare children from kindergarten to high
school to cope with daily as well as with traumatic
stressors. In 2009-2011 the School Resilience Program
trained thousands of teachers and counselors in Israel to
conduct resilience- and trauma--focused interventions.
In children trained both before and after exposure to
missiles attacks, war and natural disasters, the program
was effective in reducing by 50% their symptoms of posttrauma, anxiety, nightmares, fears, school and sleeping
difficulties, detachment and social withdrawal, compared
with children who didn’t participate in the program.
The effect of the resilience program was found to be
dramatic. After three weeks of continious missiles attacks
on the the sousthern part of Israel, the occurrence of PTSD
EABCT 2012
IW 04
Emotion Focused Therapy: An
introduction to theory and skills
Antonio Pascual-Leone1
1
University of Windsor, Canada
This in-congress is a 3 hour workshop on Emotion focused
therapy (EFT). EFT is an empirically supported treatment
that stems from a humanistic/experiential tradition.
It is founded upon a sophisticated theory of emotion
and emotional processing that has direct relevance to
the process of psychotherapy. EFT is supported by a
substantial body of research for the treatment of depression
and complex trauma, as well as for couples therapy. More
recent developments have focused on applying EFT to the
treatment of eating disorders, social phobia, and intimate
partner violence.
This seminar will present:
EABCT 2012
Key ideas about case formulation and emotion focused
theory for understanding emotion.
Overarching treatment aims and common intervention
principles in EFT.
Videotaped examples from treatments for depression and
for complex trauma.
The use of process-diagnosis to identify opportunities for
intervention
IW 05
Neuroscience based Cognitive Therapy.
New Methods for Client Assessment,
Treatment and Self Regulation
Tullio Scrimali1
1
University of Catania, Italy
Neuroscience constitutes one of the most important
components among the contemporary scientific
background. The workshop is focused in demonstrating
and treating the important topics concerning how some
recent developments of Neuroscience can be used, today
in order to better the intervention when carrying out a
Cognitive Therapy with patients affected by many different
mental disorders.
During the workshop two methods, coming from
Neuroscience Laboratories, that can be easily applied to
the clinic setting of Cognitive Therapy, will be illustrated
and explained. They are Quantitative EEG and Quantitative
Electrodermal Activity.
Such parameters can be today monitorized in the clinical
setting thanks to some new hardware and software, which
are inexpensive and that can be easily used, after a short
training, by any Cognitive Therapist.
Basic information will be given concerning how to use
such new methods when treating patients, affected by
many different mental disorders, in integration with
Cognitive Therapy.
Particularly, some data will be illustrated about mood,
anxiety, eating, and schizophrenic disorders.
More detailed information will be given about Quantitative
Monitoring of Electrodermal Activity, a new method that
Tullio Scrimali developed and experimented for many
years. This method is the simplest to be put into practice
in Cognitive Therapy an it is also the less expensive.
A new tool, called MindLAB Set, developed by Tullio
Scrimali will be carefully explained.
It is composed by a hardware, able to monitorize
Electrodermal Exosomatic Activity, which must be used
together with a computer. A specific and original software,
called MindSCAN and Psychofeedback, will be fully
illustrated.
It can be used both when assessing the patient and during
its treatment. Its allows the Cognitive Therapist to realize
17
IN-Congress
Workshops
among children in schools that adapted the program was
50% precent less compared with to those that didn’t.
(L. Wolmer, D. Hamiel, N. Laor. Preventing children’s
post-traumatic stress after disaster with teacher-based
intervention: A controlled study. Journal of the American
Academy of Child and Adolescent Psychiatry, 2011,
50:340-348).
The program was chosen by the Israeli government for a
national pilot program for the 2010-2011 school year. It is
activated now in 350 schools (approx. 250,000 students).
The plan is that in the 2012-2013 school year every child
in the country will be exposed to the program (approx. 1.5
million students).
An advantage of the program is the use of class setting and
teachers as moderators and the use of simple but effective
methods on everyday stressors, to help the children cope
and process their feelings and experiences.
The program integrates emotional, physiological and
cognitive-behavioral techniques as well as methods of
changing focus of attention (mindfulness and more) into
a self regulation method. We have simplified therapeutic
techniques into educational simple techniques that can be
used by teachers and students. An interesting finding is
that many of the techniques that have been created in the
program were found to be very effective in our therapeutic
setting as well.
The theoretic background will be reviewed with an
emphasis on practicing tools. Stress management
techniques will be taught specifically by group work,
including a demonstration of the techniques with and
without biofeedback.
The workshop is designed for clinical psychologists,
school counselors, educational psychologists, educators
and teachers.
some new interesting methods of self-regulation such as
biofeedback and Biofeedback Based Mindfulness.
During the workshop, a MindLAB Set will be used and
some practical trials, both in the field of assessment and
in that of self regulation will be carried out with the help of
some Members of the audience.
IW 06
IN-Congress
Workshops
Dialectical Behavior Therapy (DBT) for
borderline personality disorder
Jacqueline Widmer Kalochoritis1
1
Center for Psychological Well Being, Nicosia, Cyprus
Dialectical Behavior Therapy (DBT) is a comprehensive
cognitive-behavioral treatment designed for the complex
and difficult to treat patient. Initially developed by Marsha
Linehan for highly suicidal individuals, it has become
the state of the art and the most researched treatment for
borderline personality disorder. To date, ten randomized
controlled trials and many more controlled and
uncontrolled trials demonstrate its efficacy across a wide
range of clinical targets and settings.
This workshop is intended for clinicians with limited
knowledge of DBT. It will look at the theory and some of
the neurobiological research underpinning the treatment
concept. Research supporting the application of DBT to
various settings will be briefly reviewed. Finally, the bulk
of the presentation will focus on the structure and the core
treatment strategies employed in DBT.
IW 07
Interpersonal Negotiation Approach in Social
Cognitive Psychotherapy:Clinical Practice,
Peacekeeping and Cognitive-oriented
International Negotiation
Francesco Aquilar1
1
AIPOOS, Naples, Italy
In these latter years a new model to understand some
human interactions has been proposed: the Interpersonal
Negotiation Approach. This model can be utilized to
analyze: 1) the dynamics of the therapeutic relationship in
cognitive psychotherapy; 2) the interactions that the patient
develops with significant figures during psychotherapy;
3) the difficulties related to couple’s distress in cognitive
psychotherapy for couples; 4) the political national and
international conflicts and related negotiations. In this
workshop some applications of this model are presented,
in the sphere of cognitive psychotherapy (individual
and for couples) and in the sphere of cognitive-oriented
international negotiation for peace.
18
References:
-Aquilar F. (2012), Riconoscere le emozioni. Seconda edizione, Franco
Angeli, Milano.
-Aquilar F., Galluccio M. (2008), Psychological processes in
international negotiations: theoretical and practical perspectives,
Springer, New York.
-Aquilar F., Galluccio M. (2011), eds., Psychological and political
strategies for peace negotiation: a cognitive approach, Springer, New
York.
-Aquilar F., Pugliese M.P. (2011), eds., Psicoterapia cognitiva della
depressione, Franco Angeli, Milano
IW 08
A Program Designed to Prevent the Initial Episode
of Depression and Dysthymia Among Adolescents
Eiríkur Örn Arnarson1; W. Edward Craighead2
1
Landspítali-University Hospital, Iceland; 2Emory
University, Atlanta, USA
The workshop will focus on the overarching principles
and specific methods of a program designed to prevent
the initial episode of depression and/or dysthymia among
adolescents. The indicated prevention program is designed
for implementation in school settings for 14-15 year-old
students judged to be “at risk” for depression because
of the presence of some depressive symptoms and/or a
negative attributional (explanatory) style.
The program is based on a developmental psychosocial
model of enhancement of resilience to factors associated
with the occurrence of mood disorders. While sensitive
to developmental processes and gender differences,
the program incorporates and integrates principles of
interpersonal, problem solving, behavioral, and cognitive
models of psychopathology and intervention.
The focus of the group leaders’ and students’ manuals is
on the development of adaptive coping skills to enhance
self-esteem and well-being and, thereby, to prevent the
development of an episode of MDD and related problems.
Thus, the program rationale and procedures have a
positive flavor and are designed to enhance adaptive
personal development. References:
1. Arnarson, E. O., & Craighead, W. E. (2009). Prevention of depression
among Icelandic adolescents. Behaviour Research and Therapy, 47 (7),
577-585. (doi:10.1016/j.brat.2009.03.011)
2. Arnarson, E. O., & Craighead, W. E. (2011). Prevention of
Depression among Icelandic adolescents: A 12-month follow-up.
Behaviour Research and Therapy, 49 (2011) 170-174. doi: 10.1016/j.
brat.2010.12.008
IW 09
Cognitive behavioural therapy for Tourette, tic
and habit disorders
Kieron O’Connor1; Julie Leclerc1
1
University of Montreal, Canada
EABCT 2012
Reference:
O’Connor, K.P. (2005). Cognitive behavioural management of tic
disorders. Chichester: Wiley Blackwell.
IW 10
Le Questionnaire d’Analyse Fonctionnelle
Rapide du souci (QAFRS): un autoenregistrement simple pour le choix des
interventions en TCC, pour la thérapie du TAG et
des autres troubles anxieux en rapport avec le
souci
Franck Peyré1
1
Private practice, Bordeaux, France
Le QAFRS résume sur une feuille les différentes
composantes du souci, de l’évitement cognitif et des
comportements anxieux ouverts associés, ainsi que
l’évaluation de leur degré d’efficacité dans la gestion
du problème redouté, l’anxiété immédiate et l’anxiété
d’anticipation.
EABCT 2012
À chaque étape de la thérapie, ce questionnaire aide le
patient à observer et décrire le mécanisme du souci et des
comportements anxieux en rapport avec lui, au lieu de
penser et penser en mode souci-pour-comprendre :
- En élicitant les avantages de certains comportements
anxieux, le questionnaire aide le patient à comprendre la
persistance du processus anxieux.
- En introduisant l’indispensable travail motivationnel, par
la visualisation du contraste fréquent qui oppose le faible
nombre d’avantages à court terme des comportements
anxieux d’un côté, à la force du fonctionnement anxieux,
fondé sur des règles et/ou des attentes d’efficacité de
l’autre.
- En aidant thérapeute et patient à cibler ensemble des
interventions cognitives et comportementales précises aux
différents temps de la thérapie, comme :
les méthodes de résolution de problème ;
les expositions avec prévention de la réponse ou en
imagination ;
une thérapie cognitive spécifique focalisée sur l’intolérance
à l’incertitude, les raisons de se faire du souci et l’orientation
négative relative aux problèmes ;
une éventuelle gestion comportementale de l’anxiété.
Nous verrons avec des cas réels, comment utiliser ce
questionnaire tout au long de la thérapie, aussi bien dans
un processus de TCC classique qu’en association avec
des outils spécifiques du traitement du souci (par exemple
l’échelle d’intolérance à l’incertitude de M. Freeston), pour
aider le patient à observer et à combattre le processus
anxieux tout au long de la thérapie.
IW 11
Using Web-based resources for retraining
attentional and evaluative biases in emotional
disorders
Pierre Philippot1; Alexandre Heeren1
1
University of Louvain, Belgium
In the last decade, research has evidenced biases in the
processing of emotional information in different emotional
disorders. These biases can address the evaluation of
emotional stimuli or the attention that is allocated to them.
In some cases, research suggests that these biases are
not just a mere cognitive curiosity, but that they rather act
as maintaining factors of the disorders. Recent research
also indicates that these biases can be retrained and that
such retraining results in clinical benefits. In the present
workshop, we will briefly review the theoretical and
empirical background that justifies retraining evaluative
and attentional biases, more particularly in alcohol
dependency for the former, and in social anxiety for the
latter. We will then present computer-based retraining
programs that have been especially designed for clinical
19
IN-Congress
Workshops
Objectives: This workshop aims to present a cognitive
behavioral therapy for Tourette spectrum disorders.
Cognitive behaviour therapy can be an effective treatment
option for tics and habit disorders. Although the program
draws on existing behaviour therapy techniques such
as relaxation and habit reversal, the key component is
addressing anticipations about ticcing and cognitive
behavioural restructuring of expectancies and planning in
high and low situations.
Introduction: This program differs from existing
behavioural approaches in placing more emphasis on
cognition and metacognitive factors in ticcing. The therapy
also draws on empirical findings in motor psychophysiology,
and emphasizes specifically remediation of the way people
plan action and guides cognitive behavioural restructuring
of action in high risk tic situations. Unlike habit reversal,
the program prevents tic and habit onset by regulating
background activation and emotion regulation.
Method: The principle of the program is that tics result
from disregulation of motor activation and inhibition in
the planning stage of action. Consequently, people with
tics are educated in discriminating the use of muscles and
employing appropriate motor strategies during preparation
of action. The style of planning action is identified in terms
of overactivity and overpreparation. The program lasts 12
weeks and 4 weeks home practice. The stages of therapy
are described with video presentations and cases studies
illustrate the application of the program step by step.
Discussion and conclusion: The therapy has recently
been validated as an open trial where 108 people received the
therapy. Empirical psychological and psychophysiological
research findings supporting the therapy are presented.
Discussion of participant cases will be welcome.
purpose and that we have made freely available on the
Internet. The significant part of the workshop will be
dedicated to a practicum on how to use, in a clinical
setting, these retraining programs.
IW12
Cognitive therapy for schizophrenic patients
Tullio Scrimali1
1
University of Catania, Italy
IN-Congress
Workshops
Schizophrenia is the central problem in the sciences of the
mind, not only for its etiological, psychopathological, and
clinical aspects, but also because of its implications for
therapy and rehabilitation.
Keeping in mind the burden of suffering this condition
entails for patient and family, as well as its enormous social
costs, it is clear why schizophrenia is one of the most
important challenges for psychiatry, clinical psychology,
psychotherapy, and rehabilitation today. When faced
with this dramatic and complex reality, one is forced to
admit the persistent backwardness in scientific knowledge
regarding the dynamics of this disorder and, above all, the
lack of a systematic and satisfying treatment.
During the workshop, the Author will illustrate and
demonstrate how to put in practice a new therapeutical and
rehabilitative approach to the schizophrenic patient. Many
topics will be treated such as: Crisis intervention
A complex approach to the topic of medication
Multimodal assessment of the patients
Multimodal assessment of the Family
Expressed Emotion evaluation by the Five Minute Speech
Sample (Magana A.B. et Al., 1985)
The Family Strange Situation Procedure (Scrimali T.,
2008)
Self-control, Biofeedback and Mindfulness
Managing and Treating Hallucinations
Analyzing and Curing the Delusional Process
Neuropsychological assessment and Rehabilitation
Attention
Memory
Face recognition
Emotional understanding and meta-cognition
Strategic planning
Treating Negative Symptoms
Social Skill Training
Work and Social Reinstatement
Monitorizing the warning signs and avoiding any relapses
Analyzing and Changing the Self-Narrative
20
IW 13
Understanding Complex Problems: The Case
Formulation Approach In CBT
Michael Bruch1
1
University College London and London Metropolitan
University, United Kingdom
Background: The case formulation approach is an
individualised assessment treatment procedure guided
by clinical-experimental methodology and cognitivebehavioural principles. The main goal is to develop
a problem formulation to explain development and
maintenance of problem behaviours, to suggest an
intervention hypothesis, to facilitate suitable evaluation
methods and to guide development of tailor made
intervention programmes. This model was originally
inspired by HJ Eysenck and pioneered by Vic Meyer in
the context of complex psychiatric disorders, such as
personality disorders. The approach can be contrasted
to the so called ‘technique-symptom matching’ practice
in CBT which has been shown to be inappropriate and
limited for real problems in the real world.
Key Learning objectives: This workshop will present the
current status of the UCL case formulation model and is
suitable for all levels of experience in CBT. It is especially
recommended for beginners who are keen to understand
the application of basic methodology underlying a learning
based therapeutic approach. Participants should have a
basic knowledge of learning principles, cognitive theories
and experimental methodology.
The workshop will offer a step by step guide covering the
following areas:
How to structure and conduct the Initial Interview,
How to selecting options for a multilevel analysis,
How to develop a formulation of problem(s) and
intervention hypothesis
How to develop a formulation guided therapeutic
relationship,
How to construct and implement Intervention / Evaluation
Strategies.
Clinical examples will be provided and participants are
encouraged to present own cases for discussion.
Training modalities: Teaching methods employed will
be both didactic (powerpoint/overhead/video) and
experiential (role plays/presentation). This shall be
adjusted to preferences and experiences of participants.
EABCT 2012
Mindfulness-Based Cognitive interventions for
Obsessive-Compulsive Disorder: Developing Way
to Trust and Validate One’s Internal Experience
Fabrizio Didonna1
1
Casa di Cura Villa Margherita, Vicenza, Italy
Obsessive-Compulsive Disorder can be conceptualized as
a severe state of ‘mindlessness’. In this workshop we shell
analyze the particular features of OCD patients relationship
with their private experience, using a mindfulness-based
perspective, and we shell understand how this rapport
might play an important activating and maintaining role in
obsessive problem. Furthermore, it will be illustrated how
mindfulness-based interventions may intervene to change
and improve the relationship of these patients with their
private experience and consequently help them to deal
with their specific cognitive biases (‘mindfulness deficits’),
which invariably lead to the obsessive phenomenology.
Preliminary research data and clinical observation suggest
that Mindfulness-based training may be a helpful and
effective intervention for individuals with OCD, in particular
if integrated with CBT. In this workshop we shall focus
on the rationale and experiential aspects of the use of a
Mindfulness-based cognitive intervention for ObsessiveCompulsive Disorder in inpatient and outpatient treatment.
The learning objectives of this workshop are:
to reach a clear understanding and conceptualization of
mindfulness with respect to OCD phenomenology;
to illustrate theory and rationale of mindfulness-based
cognitive interventions for OCD in inpatient and outpatient
treatment;
to describe how mindfulness is trained through experiential
exercises with participants and video/DVD of group and/or
individual sessions;
To illustrate a 10 session Mindfulness-Based Group
protocol for OCD with preliminary outcome data.
IW 15
L’affirmation de soi dans le couple
Frédéric Fanget1; Odile Vincenti Darbon2
1
Centre hospitalier Universitaire, Lyon, France; 2Centre
medical, Marseille, France
Au cours de la thérapie cognitivo-comportementale, les
problèmes de couple sont fréquemment abordés.
Les méthodes d’affirmation de soi classiques, fort utiles,
doivent être adaptées pour les problèmes de couple.
C’est une affirmation de soi douce, accompagnée par une
restructuration cognitive et complétée par un travail sur
les valeurs qui sera présentée. Ces trois aspects de la TCC
EABCT 2012
sont importants pour obtenir des changements profonds et
durables de la relation du couple.
Le 1 +1 = 3 est un modèle fort utile aux couples en
difficulté pour les aider à construire un couple heureux
et durables. Les 1 représentent chaque partenaire. Le 3
représente le couple, cette création à deux d’une œuvre
originale, unique à chaque couple.
L’utilité de ce modèle pour les thérapeutes sera présentée
à l’aide d’illustrations cliniques et de jeux de rôles dans
cet atelier qui fera une large place à l’interactivité avec les
participants.
IW 16
Acceptance and Commitment Therapy for anxiety
problems
Maria Karekla1
1
University of Cyprus, Nicosia, Cyprus
This workshop will cover the application of Acceptance and
Commitment Therapy (ACT) for individuals with a variety
of anxiety related problems. ACT is based on the view that
most psychological difficulties and suffering are a result
of experiential avoidance and fusion with literal thinking
getting in the way of value guided action and living. ACT
teaches clients how to connect with their values, become
more accepting of the world within (thoughts, memories,
experiences, sensations etc) and move towards valued action
and change in their lives. Concepts will be illustrated using
live demonstrations, experiential exercises (acceptance,
mindfulness, defusion), metaphors, and worksheets. This
workshop is designed to teach basic skills needed to explore
ACT as an assessment model and intervention method.
It will be both didactic and experiential and will balance an
understanding of the model with a personal connection with
the issues raised in ACT, and with skill development. Through
this seminar participants will learn:
The basic tenets and core processes of ACT and how they can
be applied to anxiety problems
How ACT processes help explain anxiety difficulties and
provide a model of intervention
How to conceptualize cases based on ACT processes and
subsequently engage individuals to explore their values and
commit to valued living
How to use mindfulness, acceptance, experiential exercises,
metaphors and defusion techniques to bring about behavior
change
How to foster ACT processes using already existing
intervention skills and to amplify these skills using the
technology developed by ACT researchers and practitioners.
21
IN-Congress
Workshops
IW 14
IW 17
IN-Congress
Workshops
Towards new CBT interventions of anxiety
disorders – increasing patients availability to
evidence based treatment
Irene H. Oestrich1
1
Copenhagen University Hospital, Denmark
Towards new CBT interventions of anxiety disorders
– increasing patients availability to evidence based
treatment: Irene Henriette Oestrich
Short resume of in congress workshop:
“A different format are outlined: 1. An intensive CBT group
treatment programme (24 hours), illustrating how patients
suffering from panic and agoraphobia disorder overcome
their symptoms and maintain normal function after 2
weeks with documented treatment effect after one year.
Workshop topics
• Presentation of treatment programme and clinical
examples
• Psychoeducation and conceptualization
• Exposure
• Building of resilience and motivation
• Homework and generalization
• Challenging difficult cases
• The importance of homework-assignments
• Effective coping and mastering of symptoms
• CBT training and supervision - new perspectives in
the School of Cognitive & Behavioural Therapies, Mental
Health Services Copenhagen.
This workshop is a practical guide for an alternative
treatment format.
Implementation of new interventions and practices in
psychiatric clinics can improve competencies and training
standards through modelling and supervision.
This workshop is a practical guide for alternative treatment
formats. Further, data from two clinical studies will be
presented and the content of the programmes and articles
are available at the workshop.
Implementation of new interventions and practices in
psychiatric clinics can improve competencies and training
standards through modelling and supervision. With better
principles of referral, it might also help patients, who are
otherwise referred to long waiting lists or perhaps no evidence
based treatment at all with the risk of intensifying symptoms
and worsening of global psychosocial functioning.
IW 18
Pain-Related Fear in Chronic Pain: The
application of Exposure in Vivo
Johan W.S. Vlaeyen1
1
Maastricht University, The Netherlands
22
There is accumulating evidence that the lowered ability to
accomplish tasks of daily living in chronic pain patients
is not so much the consequence of pain severity. Instead,
catastrophic misinterpretations of pain and associated fear
of pain can be more disabling than pain itself. Pain-related
fear (fear of movement, physical activity and fear of reinjury) has shown to be associated with impaired physical
performance and self-reported disability, and to predict
future disability in individuals with acute pain. Inversely,
the reduction of pain-related fear (by means of exposure
in vivo and behavioral experiments) has shown to increase
functional abilities and sometimes to reduce pain severity.
The current workshop will briefly summarize the most
recent research findings on the role of pain-related fear
in chronic pain, and subsequently focus on exposure
in vivo as a novel treatment for patients with chronic
musculoskeletal pain who report substantial pain-related
fear.
The exposure in vivo treatment that is outlined in the present
workshop consists of four components: Identification
of treatment goals, establishment of a fear hierarchy,
education about the paradoxical and detrimental effects of
safety behaviors, and graded exposure to fearful stimuli
following the fear hierarchy. Through exposure, patients
are given the opportunity to correct overestimations
of the threat signaling value of the previously avoided,
conditioned stimuli. In this presentation, the mechanisms
underlying exposure treatments and its effectiveness will
be reviewed.
IW 19
La thérapie d’exposition de la phobie de
suffoquer en mangeant
Rob Faltin1
1
GGZ inGeest Amsterdam, The Netherlands
This In-Congress will be given in French
This workshop is about exposure therapy for choking
phobia. Theory and differential diagnostics will be
presented, together with the evidence-based treatment
alternatives. A video of the exposure therapy will show a
patient who fears swallowing food. The participants will
observe how the treatment rationale is repeated with client,
before, during and after the one-day-session exposure to
eating of food. The treatment begins with interoceptive
exposure, after that swallowing liquids, yogurt, until the
toughest pieces of Turkish pizza which the spouse of
our client prepared. The therapy ends with a systemic
intervention and relapse prevention. Results of Routine
Outcome Monitoring will be presented. In the workshop,
we will pay special attention to motivating techniques.
Between the video fragments, the participants will be asked
EABCT 2012
IW 20
Klärungsorientierte Psychotherapie der
Persönlichkeitsstörungen
Oliver Püschel1
1
Institut für Psychologische Psychotherapie Bochum,
Oer-Erkenschwick, Germany
Klienten mit Persönlichkeitsstörungen stellen für ihre
Therapeuten häufig besondere Herausforderungen dar:
Die Klienten fordern mitunter viel Engagement von den
Therapeuten. Gleichzeitig ist die direkte Umsetzung
veränderungsorientierter Techniken in der Regel nicht
möglich. Das Potenzial, sich über diese Klienten zu ärgern
oder sich durch ihr Verhalten frustriert zu fühlen, ist groß. Der
Workshop soll eine Einführung in die Klärungsorientierte
Psychotherapie der Persönlichkeitsstörungen nach Sachse
geben. Grundlage ist mit dem Modell der doppelten
Handlungsregulation (Sachse, 2001) eine handlungsnahe
Theorie der Persönlichkeitsstörungen. Das Modell
fasst diese Störungen in einem ressourcenorientierten
Sinn
als
Lösungen
für
motiv-frustrierende
Entwicklungsbedingungen auf. Diese Lösungen werden
für die Zeit der frühen Biografie als sinnvoll erachtet. Im
Leben des Erwachsenen führen sie zu mehr oder weniger
hohen Kosten, die vor allem im interaktionellen Bereich
liegen. In dem Workshop sollen die Besonderheiten
dieser Störungsgruppe vor allem im Bereich der
Beziehungsgestaltung herausgearbeitet werden. Typische
Schwierigkeiten mit dieser Klientengruppe wie mangelnde
Änderungsmotivation, Stabilisierungsaufträge, geringe
Mitarbeit, schwieriges Interaktionsverhalten etc.
werden erklärt und es werden Strategien zum Umgang
damit besprochen. Der Schwerpunkt des Kurses
liegt auf der Beziehungsgestaltung. Am Beispiel der
histrionischen und narzisstischen Persönlichkeitsstörung
werden typische Verhaltensmuster von Klienten mit
Persönlichkeitsstörungen thematisiert. Günstiges sowie
ungünstiges Therapeutenverhalten sollen herausgearbeitet
werden. Im Kern wird vorgeschlagen, sich als Therapeut
motiv-befriedigend zu verhalten (siehe z.B. Caspar, 2007;
Kramer et al., 2011), ohne in manipulative Strategien der
Klienten verstrickt zu werden. Besonderer Wert wird auf eine
wertschätzende aber gleichzeitig fordernde Grundhaltung
gelegt. Konkrete Handlungsvorschläge werden anhand
von Video- und Audioaufnahmen von Therapiesitzungen
(Positiv- und Negativbeispiel) illustriert.
EABCT 2012
IW 21
Anxiety Disorders across the Lifespan: Nature,
Assessment and Treatment
Ronald M Rapee1 and Viviana Wuthrich1
1
Macquarie University, Sydney, Australia
Anxiety disorders are the most common form of mental
disorder and are responsible for large personal and social
costs within most societies. Anxiety disorders are also one
of the more chronic forms of mental disorder and show little
remission across life. Most anxiety disorders begin early in
life with the majority of adults suffering anxiety reporting
onset before the age of 18 and many reporting anxious
symptoms and «personalities» from birth. Anxiety disorders
are highly prevalent at most stages of the lifespan - from
early childhood into later adulthood. From middle age, their
prevalence decreases slightly, but anxiety is still common
and can still have marked impact right into older age. Thus
it is likely that many people will seek treatment for anxiety
at several stages of their life and with improvements in
public awareness, therapists are more commonly receiving
clientele from across the life spectrum.
The current workshop will explore anxiety disorders at
relevant developmental stages including early to middle
childhood, adolescence, adulthood, and older age. We will
examine both similarities as well as differences in nature and
presentation at each of these vital periods. The workshop
will begin by looking at presentation of disorders at different
life stages and will then proceed to consider assessment
methods and relevant instruments. Finally, several treatment
programs that we run in our Centre and are aimed at different
life stages will be discussed. These include Cool Kids aimed
at anxious children, Cool Teens for anxious teenagers, and
Ageing Wisely a program for older adults with mixed anxiety
and depression. IW 22
Teaching mindfulness: The art and process of
facilitating inquiry in MBCT
Antonia Sumbundu1; Mark Williams1
1
Oxford University, United Kingdom
As mindfulness teachers we intentionally practice meeting
the present moment with curiosity and interest. Attending
to ourselves and others with non-judgmental interest
is regarded as the foundation for the skillful inquiry
into others direct experience, which aims at supporting
them in an openhearted investigation of questions, selflimiting views and open up to new understandings and
deeper knowledge. Teaching mindfulness can be seen as
consisting of different, but related, components and of
23
IN-Congress
Workshops
to exercise with some interventions aimed at motivating
a client into exposure exercises. Participants are asked to
bring some of the breakfast with them in order to practise
during the workshop. The video presents highlights of a
Dutch speaking exposure therapy of a client from Turkey. A
French translation will be provided.
IN-Congress
Workshops
these leading the inquiry process often raises the most
questions and is experienced by many teachers as both
the most challenging and exciting part.
This workshop aims at helping you to facilitate the inquiry
process in MBCT, by
• Linking self-inquiry as part of our personal practice with
the process of facilitating inquiry in groups
• Presenting different models that may support our
understanding of the inquiry process
• Exploring some of the group dynamic skills of MBCT
teachers
This 2 hour workshop on inquiry in MBCT will give
participants the opportunity
• Explore different inquiry process
• Learn about some of the theoretical models that may
support the inquiry process
• Cultivate deeper familiarity with the practice of inquiry
specific interventions such as gradual exposure to vaginal
penetration will be explained. A recently developed, highly
effective, therapist -aided exposure therapy for women
with lifelong vaginismus will be presented.
Various instructional technologies will be employed
during the workshop including didactic instructions,
video of treatment, demonstration of clinical interventions
through case examples, role-play exercises, and group
discussion.
You will learn:
- To recognize and distinguish the various female sexual
disorders;
- To understand the core elements of assessment and
treatment of female sexual disorders.
IW 23
Sexual Disorders in Women: Assessment and
Treatment
Moniek ter Kuile1 and Aart Beekman1
1
Leiden University Medical Center, The Netherlands
This workshop addresses the assessment and management
of a range of sexual problems of women that present in
clinical practice: lack of desire, arousal and orgasm, and
sexual pain. Epidemiologic research shows a relatively
high prevalence of female sexual disorders. Yet, for various
reasons such as patient or therapist embarrassment or
lack of knowledge, healthcare providers and their patients
generally avoid the topic in clinical practice.
Part 1 of this workshop will focus on female sexual desire,
arousal and orgasmic problems. Using case examples,
common clinical presentations of these problems in women
and couples will be discussed as well as diagnostic criteria
for desire, arousal and orgasmic disorder. Biopsychosocial
models of the female sexual response will be addressed
that acknowledge the importance of sexual arousability,
sexual stimuli, emotional intimacy, and psychological
factors in female sexual responding. Topics to discuss
with the patient and her partner during assessment will
be outlined. The common cognitive behavioral treatment
protocols, including specific homework assignments such
as sensate focus and sexual stimulation exercises, will be
explained.
Part 2 of the workshop will focus on sexual pain
disorders including dyspareunia and vaginismus. Using
case examples, common clinical presentations of these
problems and diagnostic criteria will be discussed. The
working models underlying the assessment and treatment
of dyspareunia and vaginismus will be outlined. A cognitive
behavioral protocol for sexual pain disorders, including
24
EABCT 2012
Symposia
Symposium 1 - Neural mechanisms
underlying cognitive and
physiological stress resilience: The
basics for the development
of new interventions?
S01-01
Neural correlates of emotion regulation:
The habitual use of cognitive reappraisal is
associated with enhanced prefrontal control for
negative information
Rudi de Raedt1; Marie-Anne Vanderhasselt1
1
Ghent University, Belgium
Symposium
1
Introduction: Emotion regulation, the ability to
control the experience of emotions, is associated with
increased neural activity in the prefrontal cognitive
control network. It can be considered as a resilience
factor for affective disorders. Cognitive reappraisal
and expressive suppression are two different emotion
regulation strategies used to cope with stressful
situations, but their underlying mechanisms of action
are not yet completely understood.
Objectives and Methodology: We investigated
whether individual differences in habitual reappraisal
and suppression tendencies are related to differences in
prefrontal cognitive control processes. Thirty-one healthy
participants performed the Cued Emotional Conflict Task
(CECT) during event-related fMRI, measuring cognitive
control to inhibit a dominant response to happy or sad
stimuli (in favor of the opposite valence). The Emotion
Regulation Questionnaire was used to measure individual
differences in everyday use of emotion regulation strategies.
Results: High reappraisers were faster and exerted
more fronto-cingulate activity when inhibiting a
response to sad faces (compared to happy faces, FDR
corrected). Suppression scores, on the other hand,
were not correlated with CECT performance. However,
suppression was associated with higher amygdala
activation during the inhibition of a response to sad
faces (compared to happy faces), which indicates that
the emotional response even increased.
Discussion: Habitual reappraisal is associated with
underlying functional cognitive control processes to
inhibit a dominant response to negative material. In
individuals who have a tendency to suppress emotions,
on the other hand, efforts to control emotionally negative
material seem to have negative consequences.
Conclusion: These data suggest that learning to
reappraise the way one thinks about a potentially emotion
eliciting situation might reduce its emotional impact,
increasing resilience by enhancing prefrontal control.
26
S01-02
Working memory for emotional stimuli predicts
self-reflective ruminative thoughts: Evidence
from a prefrontal neuromodulation study
Marie-Anne Vanderhasselt1; Paulo Boggio2; Rudi de
Raedt1
1
Ghent University, Belgium; 2Mackenzie University, Brazil
Introduction: Self-reflective ruminative thoughts put
individuals at risk to experience sustained negative mood
in the future. A growing literature has found an association
between specific working memory operations, which are
associated with activation in the dorsolateral prefrontal
cortex (DLPFC), and the occurrence of the recurrent selfreflective ruminative thoughts.
Objectives and Methodology: The aim of this study
is to investigate whether emotion specific working
memory operations, activated by neuromodulation of
the left DLPFC, predict the occurrence of self-reflective
ruminative thoughts. More specific, anodal transcranial
Direct Current Stimulation (tDCS) of the left DLPFC during
performance the Internal Shifting Task was applied to
causally modulate the ability to shift away from emotional
versus non emotional information. After brain stimulation,
participants were asked to relax for a well defined period,
after which they completed a questionnaire to measure
momentary self-reflective rumination.
Results: Anodal tDCS versus placebo over the left DLPFC
reduced the occurrence of self-reflective ruminative
thoughts, and this relationship was fully mediated by
its beneficial influence on specific working memory
operations. Only the influence of tDCS on the ability to
shift away from negative to neutral material predicted the
occurrence of self-reflective ruminative thoughts (â = .36,
t = 2.36, p < .05). This was not predicted by shifting away
from neutral to negative material (â < .20, ps > .28), or
non-emotional material (gender) (âs < .19, ps > .31).
Discussion: The current findings point towards a causal
and functional role of working memory for negative
material, associated with DLPFC activation, underlying
self-reflective ruminative thoughts.
Conclusions: The enhancement of these processes, by
combining training with neuromodulation, might reduce
rumination in everyday life and make people more resilient
against depressive mood.
EABCT 2012
The role of the prefrontal cortex in the
modulation of Heart Rate Variability as an index
of stress reactivity: A Transcranial Magnetic
Stimulation study
Jonathan Remue1; Marie-Anne Vanderhasselt1; Chris
Baeken1
1
Ghent University, Belgium
The effects of prefrontal Transcranial Magnetic
Stimulation on endocrinological stress
responses
Chris Baeken1
1
Ghent University, Belgium
Introduction: Increased stress responses are known
to precipitate psychiatric disorders, and relapse after
successful therapy might be related to a deregulated
stress system. It has also been observed that stress
reactivity decreases after multiple episodes of depression.
Research has shown that physiological stress reactivity
is related to various biological factors, such as prefrontal
functioning. The areas of the prefrontal cortex associated
with physiological stress responses are located in regions
previously associated with emotion processing. In this
study we use repetitive Transcranial Magnetic Stimulation
(rTMS) of the dorsolateral prefrontal cortex (DLPFC) as
an experimental tool to temporarily increase brain activity,
to investigate the possible causal link between prefrontal
activity and the stress response, as measured by Heart
Rate Variability (HRV).
Objectives and Methodology: In 20 healthy, female
participants, we examined the effects of a single placebocontrolled crossover high-frequency (HF) rTMS session
over the left DLPFC on stress reactivity. After baseline HRV
measurement people received a placebo or rTMS session,
followed by HRV measurement during a stress inducting
task in which participant’s performance was negatively
evaluated. Results: After rTMS, HRV increased during the
stress induction (p < .01), while it decreased in a marginal
significant way after placebo (p < .08).
Discussion: Our results, showing positive effects of a
single rTMS session on the physiological stress response,
are indicative of the causal role of the prefrontal cortex in
stress reactivity.
Conclusions: These findings demonstrate that
modulating prefrontal regions can help countering the
physiological reactions a person experiences during
stress. This means that HF-rTMS might be used to increase
biological stress resilience. Given that stress resilience
decreases with multiple episodes, combining biological
and psychological interventions might be promising.
EABCT 2012
Introduction: Stress resilience is considered to be
an important protective factor for affective disorders
but current treatments, although beneficial at the short
term, seem unsuccessful in increasing stress reactivity.
Endocrinological reactions, such as cortisol secretion,
might increase our insight into the underlying neurocircuitry
of stress reactivity. When confronted with stressors, it
is assumed that in a healthy homeostasis system, once
the stressor has disappeared prefrontal brain areas
control hypothalamic-pituitary-adrenal (HPA) responses,
resulting in a normalization of this fronto-limbic system.
However, all current studies are correlational. Because
repetitive Transcranial Magnetic Stimulation (rTMS) of the
left Dorsolateral Prefrontal Cortex (DLPFC) might inhibit
cortisol releasing hormone synthesis and release, we used
this tool to examine endocrinological responses to stress.
Objectives and Methodology: We investigated whether
one placebo-controlled high frequency (HF)-rTMS
session could attenuate a ‘stressed’ HPA-system in 30
healthy participants. After stimulation, stress was induced
with a mental counting task where participants received
bogus negative feedback on their performance. To evaluate
the HPA-system, salivary cortisol samples were collected
at baseline and during the whole procedure.
Results: One left-sided HF-rTMS of the DLPFC did not
affect global hormonal output. However, compared to
placebo the HF-rTMS session resulted in a less sensitive
HPA system in response to the stressful task.
Discussion: Our observations are indicative of the causal
role of the DLPFC in the homeostatic balance of the stress
system.
Conclusions: As this stress system is found to be
deregulated in affective disorders, consecutive HF-rTMS
sessions in depressed samples might be effective as an
add-on to psychotherapy, to increase stress resilience.
This may hold promise to reduce relapse after successful
treatment.
27
1
S01-04
Symposium
S01-03
Symposium 2 - Recovery in addiction: From
conflicted motivation
to cognitive control
S02-01
Dissociating drug wanting and liking: Practical
and theoretical concerns
Helen Tibboel1; Adriaan Spruyt1; Jan de Houwer1
1
Ghent University, Belgium
Symposium
2
Introduction: Incentive-sensitization theory (e.g.,
Robinson & Berridge, 1993) is one of the most influential
accounts of the development and maintenance of addiction.
According to this model, addiction is determined more
by drug “wanting” than by drug “liking”. Liking refers to
the hedonic reaction to drugs, whereas wanting refers to
the incentive-motivational properties of drugs and drugrelated stimuli. Although these concepts are difficult to
disentangle functionally and conceptually, several implicit
and explicit measures have been developed, which aim
to selectively measure wanting and liking in humans.
For instance, the valence implicit association test (IAT;
e.g., Wiers et al., 2002) is supposed to reflect “liking”,
whereas other implicit measures, such as attentional-bias
tasks (e.g., Tibboel et al., 2010), are assumed to reflect
“wanting”.
Objectives and methodology: In a series of studies,
we examined whether implicit and explicit measures
of wanting and liking were differentially sensitive to
manipulations of wanting (e.g., craving inductions;
deprivation). We expected that these manipulations would
primarily affect measures of wanting.
Results: In general, measures of wanting and liking were
highly correlated and were not differentially affected by
wanting manipulations. Our findings thus did not support
the hypothesis that implicit measures of wanting and liking
capture different processes.
Discussion and conclusion: Our studies question
whether in a standard experimental approach, dissociations
can be obtained between implicit measures of wanting
and liking. Due to the lack of evidence indicating that
implicit measures of wanting selectively measure wanting,
researchers should remain cautious when drawing
conclusions about differences between wanting and liking.
S02-02
Automatic and controlled indices of motivational
conflict in alcohol dependence
Joanne Dickson1; Claire Gately1; Matt Field1
1
University of Liverpool, United Kingdom
28
Introduction: Alcohol-dependence is thought to be
characterised by motivational conflict between goals to
drink and goals to abstain from drinking, which are in turn
subserved by positive and negative alcohol cognitions,
respectively. Furthermore, this conflict may operate within
and between automatic and controlled processes.
Objective: To characterise positive and negative alcohol
cognitions in both controlled and automatic processes, and to
contrast these cognitions in alcohol-dependent inpatients
and controls.
Methodology: Alcohol-dependent patients (N = 47)
and social drinking controls (N = 40) completed a selfreport measure of alcohol outcome expectancies, and
unipolar implicit association tests (IATs), both of which
probed positive and negative alcohol-related cognitions
separately.
Results: Compared to light social drinkers, alcohol
dependent participants reported higher levels of positive
and negative alcohol expectancies. Groups did not differ
on implicit alcohol-positive associations, although
alcohol dependent participants had significantly weaker
alcohol-negative associations than controls.
Conclusions: Our findings support the view that
approach and avoidance motivation represent independent
motivational systems. At the implicit level, alcohol
dependence may be characterised by weak alcoholnegative associations (which might act as a ‘brake’ on
heavy drinking in non-dependent drinkers), rather than by
strong alcohol-positive associations.
S02-03
Good Migrations? Translating experimental
psychology paradigms into clinical applications
Frank Ryan1
1
Imperial College, London, United Kingdom
Introduction: Applying cognitive neuroscience findings
relevant to addictive behaviour can augment therapeutic
engagement, guide case formulation and contribute to the
development of novel therapeutic strategies.
Objective: It is proposed that any therapeutic intervention
that augments cognitive control is likely to deliver better
and more sustained outcomes than any intervention that
does not.
Methodology & Results: Findings pointing to deficient
cognitive control in the context of addiction are reviewed,
together with data indicating that interventions that
augment cognitive control are associated with enhanced
outcomes. Cognitive neuroscience findings indicate that
addictive behaviour evolves and endures due partly to
the recruitment of implicit cognitive processes in tandem
with impaired inhibitory control. Recovery is hampered by
relentless “bottom-up” signals that trigger impulsivity in
EABCT 2012
Cognitive Bias Modification – does it work, and if
so how?
Thomas E. Gladwin1
1
University of Amsterdam, The Netherlands
Introduction: Cognitive Bias Modification (CBM) refers
to the use of interventions in which patients are made to
repeatedly and possibly implicitly perform actions aimed
at reducing or reversing addiction-supporting cognitive
biases, or increasing their ability to exert voluntary control
over such biases. The tasks used in CBM are typically
variants of tasks previously used to measure rather than
affect biases, such as the Approach-Avoidance task or
dot-probe task. For instance, subjects may be required to
perform “push away” movements when confronted with
alcoholic stimuli, or to shift their gaze away from alcoholic
stimuli in order to detect a probe stimulus.
Objectives and Methodology: A first objective is
to determine whether CBM works. Studies have been
performed in clinical and preclinical populations, using
various CBM variants. Effects on eating behavior and
alcohol use have been shown in preclinical populations,
and recently first results have been found on relapse rates
in alcoholic patients.
An important theoretical and practical question is via
which cognitive processes CBM exerts effects. A basic
distinction, for example, is that between automatic and
controlled processes: do subjects learn to control their
automatic responses, or are their associations with drug
cues re-conditioned? To approach this question, a number
of studies have been performed and are planned, in which
various methods are being used to study the mediation
EABCT 2012
S02-05
Alcohol-avoidance training improves executive
control in male alcoholics
Mike Rinck1; Eni Becker1; Reinout Wiers2; Carolin Eberl3;
Steffen Pawelczack1; Johannes Lindenmeyer3
1
Radboud University Nijmegen, The Netherlands;
2
University of Amsterdam, The Netherlands, 3Salus klinik
Lindow, Germany
Introduction: Previous research has indicated relationships
between executive control, alcohol addiction, and alcoholrelated automatic behavior. The current study investigated
the effect of a simple behavioral training, designed to
reduce automatic alcohol-approach tendencies in alcoholdependent inpatients, on executive control.
Objectives and Methodology: A total of 287 alcoholdependent inpatients were randomly assigned to a
computer-based training of 12 sessions of 15 min each.
Using a joystick, they repeatedly pushed pictures of alcoholic
beverages away from themselves, and pulled pictures of
non-alcoholic beverages closer to themselves. In total, they
performed a maximum of 1200 times pushing alcohol away
and 1200 times pulling non-alcohol closer. Both before and
after this training, they performed a classical Stroop task in
which they named the print color of color words. The ability
to suppress color-naming interference in this task was
used as a measure of executive control. The 351 remaining
patients served as the control group, taking the Stroop tasks
without any training in-between.
Results: In the control group, Stroop interference did not
change from pre-test to post-test, neither did it change
in females who participated in the alcohol-avoidance
training. In trained males, however, Stroop interference was
significantly reduced after training.
Discussion and Conclusion: The findings shed light on
the processes involved in the training of automatic alcoholapproach tendencies. They suggest that the training does
not change automatic processes only, but also increases
executive control, at least in male patients.
29
2
S02-04
of effects, including neuroimaging, brain stimulation and
modeling and mediation studies.
Results, Discussion and Conclusion: We expect
results from current and upcoming studies on, first,
cognitive and neural mediators of CBM, and second,
interactions between CBM and brain stimulation. These
results will hopefully improve our understand of CBM and
suggest improvements.
Symposium
the face of compromised “top –down” cognitive control.
Discussion: There are three key implications for
remediation: First, implicit processes remain latent in the
clinic but can generate involuntary, unplanned behaviour
between sessions. This can undermine the therapeutic
alliance and lead to relapse and disengagement. Second,
recognition that addiction is fundamentally a disorder
of reward processing leads to more precise case
formulations. Third, cognitive neuroscience has led to the
creation of novel strategies such as those seen earlier in
this Symposium. These can migrate from laboratory to
clinic with promising, if occasionally puzzling, results.
Established techniques such as motivational interviewing
also acquire a sharper focus through a neuroscience lens.
Conclusion: Cognitive neuroscience research has
generated remarkable insights into the mechanisms of
addiction, in particular its apparent resistance to change.
These results have proved robust in the laboratory and
promising when applied in the clinic.
Symposium 3 - Mechanisms of mindfulness:
RCTs, theories and qualitative data
S03-01
Mindfulness training increases momentary
positive emotions and reward experience in
adults vulnerable to depression. A randomized
controlled trial
Nicole Geschwind1; Frenk Peeters2; Marjan Drukker2; Jim
van Os2,3; Marieke Wichers2
1
University of Leuven, Belgium; 2Maastricht University
Medical Centre, The Netherlands; 3King’s College
London, United Kingdom
Symposium
3
Introduction: Mindfulness-Based Cognitive Therapy
(MBCT) is an intervention receiving empirical support
for the prevention of depressive relapse and recurrence,
and for the treatment of residual depressive symptoms.
Positive emotions are associated with increased resilience
against depression.
Objectives and Methodology: To examine whether
MBCT increases momentary positive emotions and the
ability to make use of natural rewards in daily life. Adults
with a life-time history of depression and current residual
depressive symptoms (mean age 43.9 years, SD 9.6; 75
% female; all Caucasian) were randomized to MBCT (n
= 64) or waitlist control (CONTROL; n = 66) in a parallel,
open-label, randomized controlled trial. The Experience
Sampling Method was used to measure momentary
positive emotions as well as appraisal of pleasant activities
in daily life during six days before and after the intervention.
Residual depressive symptoms were measured using the
17-item Hamilton Depression Rating Scale.
Results: MBCT compared to CONTROL was associated
with significant increases in appraisals of positive emotion
(b* = .39) and activity pleasantness (b* =.22), as well as
enhanced ability to boost momentary positive emotions
by engaging in pleasant activities (b* =.08; all p < .005).
Associations remained significant when corrected for
reductions in depressive symptoms, or for reductions in
negative emotion, rumination and worry. In the MBCT
condition, increases in positive emotion variables were
associated with reduction of residual depressive symptoms
(all p < .05).
Discussion and Conclusion: MBCT is associated with
increased experience of momentary positive emotions,
greater appreciation of, and enhanced responsiveness to
pleasant daily-life activities. These changes were unlikely
to be pure epiphenomena of decreased depression and,
given the role of positive emotions in resilience against
depression, may contribute to the protective effects of
MBCT against depressive relapse.
30
S03-02
Cognitive and momentary affective mediators
explaining the mechanisms of effect in MBCT
Marieke Wichers1; Tim Batink1; Nicole Geschwind2; Jim
van Os1,3; Frenk Peeters1
1
Maastricht University, The Netherlands; 2University
of Leuven, Belgium; 3King’s College London, United
Kingdom
Introduction: It has recently been shown that changes in
rumination and worry mediated the reduction of depressive
symptoms in Mindfulness-Based Cognitive Therapy
(MBCT). This study aims to replicate this finding and to
include additional momentary affective measurements to
examine the full pathway of changes involved in the effects
of MBCT.
Objectives and Methodology: To examine whether
mindfulness skills, rumination, worry, negative and
positive affect mediated the effect of MBCT on depressive
symptoms. Furthermore, it was examined, how effects of
rumination and worry on reduction in symptoms were
mediated by affective changes. Mediation was examined
separately for individuals with 3 or more, and 2 or less
previous depressive episodes. Adults with a life-time
history of depression and current residual depressive
symptoms were randomized to MBCT (n = 64) or waitlist
control (CONTROL; n = 66) in a parallel, open-label,
randomized controlled trial. Sobel mediation tests were
used for the analyses.
Results: In individuals with ≤2 previous episodes change
in mindfulness skills mediated the effect of MBCT on
change in worry (53%). Furthermore, change in worry
significantly mediated the effect on reduction in depressive
symptoms (86%). Changes in positive (31%) and
negative (33%) affect further mediated the effect of worry
on symptom reduction. In individuals with 3≥ previous
episodes the effect of MBCT was not mediated by change
in dimensions of mindfulness skills. However, change in
positive affect (80%) directly mediated the effect of MBCT
on depressive symptom reduction.
Discussion and Conclusion: Different mechanisms of
effect of MBCT on reduction in depressive symptoms were
found depending on the number of previous episodes.
Change in positive affect seems especially important in
reducing depressive symptoms in recurrent depression.
EABCT 2012
Temporal relationships between mindfulness,
rumination and depressive symptoms
Evelien Snippe1; Elisabeth H. Bos2; Karen van der Ploeg2;
Joke Fleer1; Maya J. Schroevers1
1
University of Groningen, The Netherlands; 2Lentis,
Center for Integrative Psychiatry, Groningen, The
Netherlands
Effectiveness of a mindfulness-based
psychological intervention in emotionally
distressed patients with diabetes (DiaMind): A
Randomized Controlled Trial
Jenny Van Son1; Ivan Nyklicek1; Victor Pop1; Frans
Pouwer1
1
Tilburg University, The Netherlands
Introduction: MBCT is assumed to promote mindfulness
skills, such as being aware of experiences without judging
them, which interferes with ruminative thinking and leads
to reductions in depression. There is some evidence that
mindfulness skills and rumination mediate the effects of
MBCT for depression. Yet, this evidence is derived from
studies that used mainly pre- and post-measurements.
With such a design it cannot be ruled out that depressive
symptoms diminish simultaneously with or even cause
changes in mindfulness skills and rumination. Daily
assessments during MBCT using an individual time-series
approach is a better method to study whether changes in
mindfulness skills and rumination precede changes in
depressive symptoms.
Objectives: To investigate the temporal relationships
between mindfulness skills (i.e. awareness, non-judging),
rumination and depressive symptoms during the course
of MBCT.
Methodology: Ten patients with at least mild depressive
symptoms according to the Patient Health Questionnaire
(PHQ-9 >5) who participate in a MBCT training will be
approached for the study. A single-subject time-series
approach is used. Participants will complete daily
measurements before start of the training (2 weeks) and
during the mindfulness training (8 weeks). Depressive
symptoms are measured with the Patient Health
Questionnaire-2. Awareness and non-judging are both
measured with two questions of the Five Facet Mindfulness
Questionnaire. Rumination is measured with two questions
from the Perseverative Thinking Questionnaire (items with
the highest factor loadings were selected).
Results: Data collection will be complete in June
2012. Vector Autoregressive Models will show whether
awareness, non-judging and rumination precede, go
together with or follow changes in depressive symptoms
and positive mood.
Discussion / Conclusion: With the results we aim to gain
insight in the temporal relationships between assumed
mechanisms of MBCT and depressive symptoms.
Introduction: Emotional distress in patients with
diabetes is related to unfavorable outcomes, like reduced
quality of life, sub-optimal self-care, and higher risk of
complications.
Objectives and Methodology: The purpose of this
randomized controlled trial is to test the effectiveness of
a mindfulness-based psychological intervention (MBCT)
with regard to reducing emotional distress and improving
quality of life, positive affect, and life satisfaction. So far,
77 diabetic patients have been recruited from outpatient
diabetes clinics. They were randomized to MBCT or a
waiting list control group. Assessments included the
Perceived Stress Scale, Hospital Anxiety and Depression
Scale, Profile of Mood States, Problem Areas in Diabetes
survey, Satisfaction with Life Scale, and SF-12 at baseline,
after four weeks, and post intervention. Group differences
were analyzed with a mixed models repeated measures
analysis. The study is registered in the Dutch Trial Register
(No. NTR2145).
Results: Compared to the control group, MBCT was more
effective in reducing perceived stress (pooled t (72) =
-2.03, p = .042, partial η² = .06) and depressive symptoms
(pooled t (72) = -2.06, p = .041, partial η² = .06), while a
trend was found for improvement in anxiety (pooled t (72)
= -1.66, p = .098, partial η² = .04). In addition, MBCT
was more effective in improving the mental component
of quality of life (pooled t (72) = 2.09, p = .037, partial
η² = .06), vigor (pooled t (72) = 2.04, p = .042, partial
η² = .06), and life satisfaction (pooled t (72) = 2.20, p =
.028, partial η² = .06). There were no effects of MBCT on
diabetes distress and the physical component of quality of
life (both p > .10).
Discussion and Conclusion: MBCT is effective in
reducing perceived stress and depressive symptoms and
improving quality of life, vigor and general life satisfaction
in adults with diabetes. The intervention does not affect
physical quality of life or diabetes specific problems.
EABCT 2012
31
3
S03-04
Symposium
S03-03
S03-05
Mindfulness-based cognitive therapy for patients
with medically unexplained symptoms, a
longitudinal qualitative study
Hiske van Ravesteijn1; Yvonne Suijkerbuijk1; Peter
Lucassen1; Anne Speckens1
1
Radboud University Nijmegen Medical Centre, The
Netherlands
Symposium
4
Introduction: Medically unexplained symptoms are
ubiquitous, cause major distress and there is a lack of
effective treatments. Mindfulness-based cognitive therapy
(MBCT) is an 8-week course developed for patients
with recurrent depressions that integrates mindfulness
meditation practices and cognitive theory. Because of the
difficulty in acceptance of their symptoms and the role
of emotions, cognitions and behavior in initiating and
maintaining unexplained symptoms, we hypothesized
MBCT might be of benefit for this group of patients.
Objectives: The aim of this study was to explore the
processes by which MBCT may benefit patients with
medically unexplained symptoms as part of a randomized
controlled trial conducted among 125 frequent attenders
in primary care.
Methodology: Qualitative research was conducted
using analytical induction as part of a grounded theory
approach. A purposive sample of 12 patients from the
trial were interviewed about their experiences by semistructured and open interviews on a longitudinal basis.
The interviews were conducted at three different stages:
before the training, directly after completion and one year
after completion of the training. Interviews were transcribed
verbatim and analyzed by using Atlas.ti. During the coding
process themes emerged from the data. We are currently
analyzing the data, the results are preliminary.
Results: Three main themes emerged from the analysis:
acceptance of symptoms, insight and self-care. Patients
who experienced improvements in these fields mentioned
higher levels of well being, both mental and physical, one
year after completion of the training.
Conclusion: In the preliminary analysis the mechanisms
of acceptance, insight and self-care appear the most
important mediators. MBCT might lead to increased selfefficacy in patients with medically unexplained symptoms.
A larger mixed-method study is necessary to examine the
mechanisms which were found in our sample.
32
Symposium 4 - Non-suicidal self-injury in
adolescents: New developments
S04-01
Adolescents with self-harming behavior: Which
problems are reported by themselves?
Eva Vonderlin1; Johann Haffner2; Barbara Behrend1;
Romuald Brunner2; Peter Parzer2; Franz Resch2
1
University of Heidelberg, Germany; 2Universitätsklinikum
Heidelberg, Germany
Introduction: Non-suicidal self-injury (NSSI) does not
only occur in clinical samples, community based studies
showed prevalence rates from 6-7 % among adolescents
(De Leo & Heller, 2004; Hawton et al., 2002). Therefore
NSSI should not longer been seen as a symptom of severe
psychiatric disorder, but also as a strategy of emotion
regulation widely accepted by young people. The aim
of this study was to ask students reporting NSSI which
problems they experience in their everyday life.
Objectives and Methodology: A representative sample
of 5832 students at Heidelberg (Germany) filled in a
questionnaire on mental health, living conditions, risk
behavior and everyday problems (Brunner et al., 2007).
Repetitive deliberate self-harm was reported by 4% (n
= 220). Occurrence of NSSI was higher among female
students and students of lower level academic tracks.
The frequency of a number of problems mentioned in this
group (NSSI) were compared to a control group without
NSSI (CG) matched for gender and type of schooling.
Results: Relationship problems within the family and with
peers were reported more frequently in NSSI. Furthermore
students with NSSI showed less self esteem and more
alcohol and drug use than controls. Experience of loss
and violence occurred more often in NSSI but only in few
cases. Rate of suicide attempts was high in NSSI (56% vs.
4%). Counselling or treatment was reported by a quarter
of self-harming students.
Discussion and Conclusion: Interpersonal problems
seems to be highly relevant for adolescents with NSSI.
Supporting relational and communicative competences
should therefore be an important goal in psychotherapy.
Despite rate of suicide attempts was high only a minority
in NSSI received treatment. More research is necessary to
develop special treatment opportunities for this age group.
EABCT 2012
S04-03
Facial mimicry of dynamic emotional facial
expressions in adolescents with non-suicidal
self-injury
Tina In-Albon1; Martina Bürli1; Mara Bruggisser1; Marc
Schmid1
1
University of Basel, Switzerland
Objectives: An important factor in social interactions is
the way one responds to emotional facial expressions.
Facial mimicry, the tendency by which people in social
situations imitate or mimic the facial expressions of
others, encourages relationships and empathy and
therefore represents an important social reaction that may
also be deficient in non-suicidal self-injury (NSSI). Facial
mimicry is an important prerequisite for emotion regulation
(ER). Because adequate ER is important for initiating and
maintaining interpersonal relationships, adolescents
with NSSI experience interpersonal communication as
problematic and distressing, further contributing to their
symptoms. This study investigates whether patients with
NSSI have deficits in facial mimicry, which could lead to
problems in social interactions, which could trigger NSSI
EABCT 2012
S04-04
Online Non-Suicidal Self-Injury: Motivations,
Addiction and Secrecy
Karen Rodham1; Jeff Gavin1; Stephen Lewis2
1
University of Bath, United Kingdom; 2University of
Guelph, Canada
It is becoming more common for individuals to share
experiences of NSSI virtually via photographs, videos and
online discussions. Although much of the work exploring this
phenomenon has reported negative effects, Baker and Fortune
(2008) suggest that the focus on the negative may be a little
hasty. For example, the Internet may be a way to connect
otherwise isolated individuals, be an opportunity to receive
support from like-minded individuals and find a community
that understands their NSSI. In this paper, we draw together
data we have collected from a series of studies examining
how and why NSSI is shared in image platforms within NSSI
e-communities. Each of these benefits involves sharing NSSI
experiences with others; that is, they require that these private
behaviours become public – at least, in a virtual setting. It
is this aspect that we have been exploring in some depth. In
this paper we explain our findings concerning the motivations
for making what is typically private behaviour. In particular we
focus in-depth on the notion that NSSI is addictive. Having
established a variety of motivations for contributing posts
to an online forum, we wanted to develop this further by
expanding our analysis to focus on the relationship between
the text and accompanying photographs of NSSI. Doing so
enabled us to explore in greater detail the paradox (mentioned
above) of openly presenting through text and photographs, a
behaviour which is generally regarded in the offline world as
something that ‘should’ be hidden. In presenting our findings,
we also comment on the process and ethics of using the
Internet as a resource for data collection.
33
4
Emotional regulation and facial emotion
recognition in adolescents with non-suicidal
self-injury
Martina Bürli1; Eva Schönbächler1; Marc Schmid1; Tina
In-Albon1
1
University of Basel, Switzerland
Non-suicidal self-injury (NSSI) can be seen as an
inadequate strategy to regulate negative emotional states.
Adolescents with NSSI often report to injure themselves
to cope with negative affects or dissociative states.
Accordingly, emotion regulation abilities are of high interest
in NSSI. The construct of emotional intelligence includes
facial emotion recognition as a prerequisite of an adequate
regulation of emotion. In the present study, facial emotion
recognition ability is investigated using dynamic facial
expressions, changing slowly form a neutral face to an
emotional expression. Reaction time and response accuracy
were the depending variables. The participant’s current
mood state was controlled using brief film clips evoking a
negative and a neutral mood state. Self-reported emotion
regulation ability was measured using the German versions
of Difficulties in Emotion Regulation Scale und the TorontoAlexithymia-Scale. So far, 21 adolescents with NSSI and
36 healthy controls participated. Recruitment is ongoing.
Preliminary results will be presented and discussed.
- and lead to a vicious circle, perpetuating the problem.
Methods: Therefore, we investigate participants’ facial
reactions to different dynamic emotional facial expressions
(anger, sadness, neutral, sadness, anxiety, happiness)
using facial electromyography (EMG). For the dynamic
facial expression we use a morphing technique, in which
participants see sequences of neutral faces slowly changing
to full-intensity of emotional expressions. In addition to
the facial mimicry, facial emotional recognition and the
influence of the current emotional state are investigated.
Results: So far, we investigated 20 female patients
with NSSI, 10 clinical controls and 20 healthy controls,
though recruitment is ongoing. Preliminary results
indicate that the facial mimicry effect could be replicated
using dynamic facial expressions and that mood has
on influence on facial mimicry in patients with NSSI.
Further results will be presented and discussed.
Symposium
S04-02
Symposium 5 - Special interest group (SIG)
on OCD: Update and recent findings from
the research and clinical practice
S05-01
Symposium
5
Neural correlates of abnormal ‘guilt processing’
in patients with obsessive-compulsive disorder
Barbara Basile1,2; Marco Bozzali2 ; Emiliano Emiliano2;
Francesco Mancini1
1
School of Cognitive Psychotherapy, Rome, Italy;
2
Neuroimaging Laboratory, Santa Lucia Foundation,
Rome, Italy
Guilt appears to play a role in the occurrence and
maintenance of obsessive compulsive disorder (OCD).
Patients are particularly sensitive to deontological guilt
(DG), and not to other kinds of guilt, such as altruistic
guilt (AG). The aim of the current fMRI study is to assess
whether the role postulated for guilt in OCD is supported
by an abnormal processing of guilt, and more specifically
of DG. 13 patients with OCD and 19 healthy controls
(HC) were recruited. Psychological tools to assess/
exclude OCD symptoms and to quantify guilty feeling
were administered. Emotional paradigm is based on the
presentation of specific stimuli, selectively inducing
DG, AG, anger and sadness (as control conditions).
Psychological tools confirmed the diagnosis of OCD, also
confirming patients’ higher attitude in experiencing guilt.
Consistently, behavioural fMRI responses revealed that
OCD felt more guilty in both guilt conditions, compared
to HC. fMRI results, showed that both guilt conditions
revealed decrease of activity in the anterior cingulate
cortex (ACC) of OCD patients, compared to HC. When
separately considering each type of guilt, patients showed
decreased activation in the ACC and the insula, for DG,
while no difference was observed in AG. Interestingly,
OCD patients activated more than controls in response to
both basic emotions. OCD patients reported more guilty
feelings on psychological assessments, as well as during
fMRI task performance. fMRI results suggest that patients
have reduced activation in the ACC when experiencing
guilt, regardless of its specific type (DG or AG). As guilt
is a more cognitively structured emotion, we suggest a
release of inhibition of this area on more basic emotion
circuits. Consistently an abnormal processing of DG, but
not of AG, was distinctive of OCD. Our findings suggest
that OCD might depend on the release of inhibition on
neuronal circuits subserving a specific complex emotion
(such as DG) patients’ are more vulnerable to.
34
S05-02
Relationship-related obsessive-compulsive
(OC) symptoms: The case of partner focused OC
phenomena
Guy Doron1
1
Interdisciplinary Center (IDC) Herzliya, Israël
Introduction: Obsessive-compulsive disorder (OCD) is a
disabling disorder with a variety of clinical presentations.
Recently, research has begun to explore relationshipcentered obsessive-compulsive (OC) symptoms, which
include obsessions, checking, and reassurance seeking
behaviors centered on intimate relationships.
Objectives and Methodology: The present investigation
extends previous research by examining OC symptoms
focused on one’s partner’s perceived flaws. We report on
the development and validation of the Partner-Related
Obsessive-Compulsive Symptoms Inventory (PROCSI),
a 24-item self-report scale assessing the severity of
partner-focused OC symptoms in six domains: physical
appearance, sociability, morality, emotional stability,
intelligence and competence.
Results: The PROCSI was found to be internally
consistent, and its factorial structure was supported by
confirmatory factor analysis. The PROCSI showed the
expected associations with measures of OCD symptoms
and cognitions, negative affect and relationship
functioning, and significantly predicted depression
and relationship-related distress over and above other
symptom and relationship measures (Study 1). In addition,
longitudinal analyses suggested reciprocal links between
relationship-centered OC symptoms and partner-focused
OC symptoms (Study 2).
Discussion and Conclusion: our findings indicate
that the PROCSI captures a distinct theoretical construct
that may have a unique predictive value. Implications for
theory and treatment will be discussed.
S05-03
Inhibition deficit model for the etiology and
treatment of obsessive-compulsive disorder
Gideon E. Anholt1; Omer Linkovski1; Eyal Kalanthroff1;
Arishai Henik1
1
Ben-Gurion University of the Negev, Beer Sheva, Israel
Current obsessive-compulsive disorder (OCD) models
suggest that catastrophic misinterpretation of (normally
occurring) intrusive thoughts underlie etiology and
maintenance of OCD symptoms. However, little is known
about the reasons some individuals develop beliefs
leading to this misinterpretation of intrusive thoughts.
EABCT 2012
S05-04
A randomized controlled trial testing the specific
effects of adding an internet-based booster
program for obsessive-compulsive disorder
Erik Andersson1; Sara Steneby1; Kerstin Karlsson; Brjann
Ljotssson1; Erik Hedman1; Jesper Enander1; Viktor Kaldo1;
Gerhard Andersson1,2; Nils Lindefors1; Christian Rück1
1
Karolinska Institutet, Stockholm, Sweden; 2Linköping
University, Sweden
Background: Relapse is common among patients with
obsessive-compulsive disorder (OCD) who have received
cognitive behavior therapy (CBT). Booster programs are
recommended in most CBT treatments for OCD to improve
long-term outcome. However, there are no randomized
controlled trials testing the specific effects of booster
programs.
Aim: To test the specific effects of adding a booster
program.
Method: 50 out of 100 participants were randomized to
also receive a 3-week internet-based booster program as
an adjunct to CBT. The treatment was conducted 6 months
after receiving completion of the main CBT treatment.
Main outcome is the Yale-Brown Obsessive compulsive
scale using blinded assessors.
Results: All assessments will be completed in June.
EABCT 2012
Preferential Early Memory Recall for OnceNeutral Objects after the Introduction of Threat
Jessica M. Senn1; Adam S. Radomsky1
1
Concordia University, Montreal, Canada
Introduction: Research has shown that increased
attention at encoding enhances the likelihood of
subsequent increased memory. Thus, a memory bias for
threat may result from increased attention at encoding. It is
important to verify if a memory bias for threat operates as
a separate process or is simply a by-product of attentional
bias for threat.
Objectives and Methodology: To assess whether a
memory bias for threat emerges when threat information is
provided about once-neutral stimuli (neutral at encoding)
in the absence of attentional bias. It was hypothesized
that a memory bias for threat would lead to earlier recall
of threat stimuli compared to neutral stimuli. Participants
interacted with neutral objects displayed in two boxes, and
completed a recall memory test. Participants then received
new neutral (No-Threat condition) or new threatening
(Threat condition) information about half of the objects;
the other half remained neutral. A second recall memory
test was administered. A percentage score was calculated
to see how many of the first five objects recalled at each
time point were manipulated objects (i.e., those for which
new neutral or threatening information was provided).
Results: Individuals in the Threat condition showed a
higher percentage of manipulated items recalled in the
first five items than did those in the No-Threat condition,
F(1,79)=4.58, p=.04, ηp²=.06.
Discussion and Conclusion: Results support a memory
bias for threat in the presumed absence of attentional bias
at encoding. Individuals given threatening information
(compared to neutral information) about previously neutral
objects showed preferential early recall for these objects
compared to those that remained neutral. These results
support the notion that memory bias for threat is not
simply a by-product of increased attention. Results will be
discussed in terms of the role of memory bias in anxiety
disorder onset and its relation to cognitive-behavioural
treatment of anxiety disorders.
35
6
S06-01
Symposium
Repeated checking, a compulsive behavior, was found to
promote rather than decrease uncertainty even in healthy
controls. However, why do some individuals tend to check
more than others? OCD patients and their families were
found to exhibit inhibition deficits relative to healthy
controls. However, to date, no studies have proposed an
OCD model integrating this basic cognitive deficiency
with current OCD models. We aim at integrating basic
cognitive findings in OCD patients with contemporary
models of OCD and propose a modified OCD model for
individual proneness to OCD, in which inhibition deficits
are associated with greater difficulty to resist behavioral
tendencies associated with intrusive thoughts. We
present preliminary findings supporting relations between
decreased response inhibition and greater uncertainty as
consequence of repeated checking. Therefore, we suggest
that individuals with weaker response inhibition may be
more likely to behaviorally respond to intrusive thoughts,
and that these reactions may become automatic over time
and underlie the development of OCD beliefs. Future
research ideas will be outlined and clinical implications,
particularly for the development of a novel intervention in
the form of inhibition training will be discussed.
Symposium 6 - Theoretical and
therapeutic implications of information
processing in anxiety disorders
Symposium
6
S06-02
S06-03
A Study of the Phenomenology and Psychology
of Compulsions
Christine Purdon1; Bianca Bucarelli1; Harjot Dosanjh1
1
University of Waterloo, Canada
Introduction: Although compulsions are a primary
complaint of most people who suffer from OCD we
know surprisingly little about their phenomenology.
What behaviours constitute a compulsive act and what
psychological factors predict its behavioural components?
Objectives and Methodology: The purpose of the
current study was to examine the phenomenology and
psychology of compulsions in an in vivo checking task.
In the study, 20 individuals with a principal diagnosis of
OCD (n = 15 collected to date) are left on their own in our
lab kitchen, and, while being videotaped, boil water on a
stove, turn the burner off, and place a pot of dry rice on that
burner before rejoining the researcher. Prior to the task,
participants complete a battery of measures including
tests of memory confidence and attention control. Ratings
of responsibility for, and probability and severity of,
harm are taken before and after the task. After the task,
ratings of memory confidence and certainty that the task
was completed properly are also taken. Matched anxious
controls complete the same task. Drawing from Eilam and
colleagues (2006), coders blind to the diagnostic status
of participants list the content of each separate behavior
during the task.
Results: Data from matched pairs will be analyzed to
determine the number of behaviours that are shared by
both groups versus being unique to participants with
OCD. The behavioural indices of the checking task will
be examined in relation to psychological factors. It is
hypothesized that the number of unique behaviours and
repetitions of behaviours will be directly predicted by pretask memory confidence and greater perceived harm, and
that these indices will in turn predict post-task perceived
harm and memory confidence, controlling for pre-task
ratings.
Discussion and Conclusion: Results will be discussed
in terms of implications for understanding the persistence
of compulsions and subsequent treatment implications.
Does Dual-Tasking Attenuate the Return of Fear
after Extinction?
Arne Leer1; Iris M. Engelhard1; Pauline Dibbets2; Marcel
A. van den Hout1
1
Utrecht University, The Netherlands; 2Maastricht
University, The Netherlands
Introduction: Return of fear following exposure may
be explained by ABA-renewal: fear acquired in context
A, extinguished in context B, may return in context
A. Conditioning theory predicts that conditioned fear
intensity is mediated by the mental representation of the
unconditioned stimulus (US) evoked by the conditioned
stimulus (CS).
Objectives and Methodology: To test whether USdevaluation via a dual-task – imagining the US while
making eye movements – attenuates fear renewal, using
self-report and physiological data. Participants acquired
fear in context A and underwent extinction in context
B. Next, one group did a filler task, one the dual-task,
and one merely imagined the US. Finally, participants
were re-presented the CSs in both context A and B (in
a counterbalanced order). Fear learning was assessed
with online US-expectancy ratings as well as acoustic
startle responses that were hypothesized to increase
during acquisition and to decrease during extinction.
Fear renewal was operationalized as greater renewed
responding at test in context A compared to context B. In
addition, emotionality and vividness of the US memory
were assessed before and after the intervention.
Results: We will examine whether the dual-task group
shows decreases in vividness and emotionality of the US
memory in the course of intervention and less fear renewal
in the test phase compared to the other groups.
Discussion and Conclusion: Results will be presented
at the conference. Theoretical and therapeutic implications
will be discussed.
36
EABCT 2012
S07-01
Shame autobiographical memory: An integrative
model for the relations among autobiographical
and traumatic shame memory properties, shame
feelings and psychopathology
Marcela Matos1; Kirsten McEwan2
1
University of Coimbra, Portugal; 2University of Derby,
Uinted Kingdom
Introduction: Recent evidence shows that early shame
experiences can function as traumatic memories,
eliciting intrusions, hyperarousal symptoms and
avoidance and become central to self-identity and
life story. Shame traumatic and central memories
have also been found to increase current shame
feelings and vulnerability to psychopathology.
Objectives and Methodology: The present study
extended this research by exploring the phenomenological
properties of shame autobiographical memories and how
these relate to their traumatic and centrality features and
to shame and psychopathological symptoms. Participants
(N = 412) recruited from the general population, retrieved
a shame memory from childhood or adolescence and
completed a set of self-report questionnaires measuring
autobiographical memory properties, traumatic and
centrality memory features, external shame, internal
shame and depression, anxiety and stress symptoms.
Results: Results showed that several autobiographical
memory properties were related to traumatic and centrality
qualities of the shame memory, shame feelings and
psychopathology. Across analyses strength of recollection,
reliving and similarity of emotions, importance to self and
rehearsal autobiographical memory properties were the
best predictors of measures of traumatic and centrality
features of shame memory, external and internal shame and
psychopathology. Path analysis results revealed a complex
mediational chain where reliving of emotions, importance
to self and rehearsal properties of shame autobiographical
memory indirectly predicted heightened external and internal
shame and elevated symptoms of depression, anxiety and
stress through increased traumatic and centrality qualities of
shame memory.
Conclusion: These findings offer insight towards an
integrative model of shame autobiographical memory,
its traumatic and centrality qualities, shame feelings
and psychopathological symptoms, with implications to
current conceptualization.
EABCT 2012
37
7
Enhancement of Self-Conducted ERP for OCD
using Cognitive Bias Modification
Nader Amir1; Sadia Najmi1; Jennie Kuckertz1; Sara
Conley1; Kristen Frosio1
1
San Diego State University, USA
Introduction: Exposure and Response Prevention
(ERP) is the treatment of choice for OCD. However, this
treatment is not widely available to patients. Previous
attempts at increasing accessibility (e.g., bibliotherapy,
Tolin & Hannan, 2005; BT STEPSTM, Bear & Griest,
1997) have met with limited success partly due to high
dropouts. Cognitive Bias Modification (CBM) techniques
may be one way of increasing the utility of self conducted
exposure by increasing behavioral approach towards
anxiety-provoking situations.
Objectives and Methodology: We present preliminary
findings from a pilot study of a self-conducted ERP for
OCD that is enhanced by CBM techniques. The program
consists of 15 sessions of sERP. The program is therapistdirected (i.e., exposure hierarchy generated collaboratively
by patient and therapist) and self-conducted (i.e., patient
engages in the exposure exercise without the assistance
of the therapist). A brief, computerized, CBM intervention
(Attention Bias Modification, Interpretation Training, or a
CBM control task) precedes each of the sERP sessions.
Results: Preliminary findings from an open trial with
eleven participants with OCD showed a significant drop
in Y-BOCS scores from pre-treatment (M = 30, SD = 4.0)
to post-treatment (M = 13.7, SD = 8.01), t(10) = 6.16, p <
.001, d = 4.07, which is comparable to outcomes for the
gold standard treatment for OCD. Moreover, self reported
change of OCD symptoms was significantly greater during
weeks where exposure were preceded by CBM than weeks
preceded by control condition.
Discussion and Conclusion: These results suggest that
this novel treatment which requires only an initial session
with a clinician trained in ERP, has the potential to increase
both the accessibility and acceptability of self-conducted
ERP for patients with OCD.
Symposium 7 - Trauma, emotions and PTSD
Symposium
S06-04
S07-02
Symposium
7
Emotions in PTSD: A generalizability study
Tuva Øktedalen1
1
Modum Bad, Research Institute, Oslo, Norway
Consistent with the diagnostic emphasis on fear, PTSD
is viewed as maintained by excessive fear of stimuli that
reminds of the trauma, excessive fear associated with
the trauma memory, and fear of the anxiety reactions
themselves. However, traumas are highly emotive events
and a variety of emotions and not only fear may have an
impact on the development and maintainment of PTSD in
the aftermath of trauma. In particular, current definitions
emphasize fear, but current theorizing and increasing
evidence (Holmes, Grey & Young, 2005; Grey & Holmes,
2008; Grunert, Weis, Smucker, & Christianson, 2007)
suggest that non-fear emotions such as anger, guilt and
shame may be important features of PTSD. The substantive
issue to be addressed was to investigate the relationship
between the trauma-related shame, guilt, anger and fear
and various aspects of the PTSD symptoms. This study
uses a multivariate generalizability study as its empirical
approach to the dimensionality question. The purpose of
this study is threefold: First, to further explore the effect of
the analysis design on estimates of variance components,
reliability and standard error of measurement. Second, to
investigate the divergent validity between fear, shame and
guilt. Finally, to investigate the relationships between the
different emotions shame, guilt and fear, and the various
aspects of PTSD symptoms defined by diagnostic criteria.
(DSM4). In light of the upcoming revision of DSM-5
this article proposes an empirical investigation of the
importance of non-fear emotions in PTSD.
S07-03
Improving emotional processing in the treatment
of PTSD: A theoretical comparison of imagery
exposure and imagery rescripting
Asle Hoffart1
1
Modum Bad, Research Institute, Oslo, Norway
Prolonged exposure (PE), where imagery exposure (IE)
of the traumatic memories is a central part, has received
substantial empirical support as an efficacious treatment
for posttraumatic stress disorder (PTSD). IE focuses the
fear and anxiety re-experienced in the traumatic memories.
However, there is increasing evidence indicating that nonfear emotions – such as anger, guilt and shame – also
are predominant in traumatic memories in PTSD patients.
Thus, it may be important to develop additional methods to
IE to address such non-fear emotions. In this presentation,
38
I will describe and compare two imagery methods: imagery
exposure and imagery rescripting. In particular, I will
theoretically analyze and compare the procedures and the
mechanisms of maintenance and change that may support
these therapies.
S07-04
Comparing imagery exposure or imagery
rescripting as a component of prolonged
exposure: A randomized controlled trial on the
moderating effects of non-fear emotions
Tomas Langkaas1
1
Modum Bad, Research Institute, Oslo, Norway
Posttraumatic stress disorder (PTSD) is usually
conceptualised as an emotional disorder with excessive
fear and avoidance at its core. However, sufferers of PTSD
often present other distressing emotions associated with
the traumatic event such as anger, shame, guilt, sadness
and disgust (eg. Grey & Holmes, 2008). This has led
researchers to hypothesize that other emotions than
fear may serve important functions in the development,
persistence and treatment of this disorder (eg. Dalgleish
& Power, 2004). Imagery Rescripting and Reprocessing
Therapy (IRRT; Smucker, 1995) has been proposed as a
treatment to PTSD that is potentially more effective than
exposure-based treatments when non-fear emotions are
predominant in the trauma symptoms (Smucker, Grunert,
& Weis, 2003). In this study, 71 patients diagnosed with
PTSD were randomly assigned to treatment according to
either the standard protocol of Prolonged Exposure (Foa,
Hembree & Rothbaum, 2007) or a modified protocol. In
the modified protocol, the imaginal exposure interventions
were replaced with the imagery interventions from
the treatment protocol of IRRT. Several trauma-related
emotions, including fear, anger, sadness, guilt, shame and
others were assessed before treatment and weekly during
treatment. Analysis of the moderating effects of emotions
on the two treatments will be presented.
EABCT 2012
Worry in Imagery or Verbal Form and its Impact
on Working Memory Capacity
Eleanor Leigh1; Colette Hirsch1
1
King’s CoIlege London, United Kingdom
Introduction: Worry-prone individuals have less residual
working memory capacity during worry compared to lowworriers (Hayes et al., 2008). People typically worry in
verbal form, and the present study investigated whether
verbal worry depletes working memory capacity more than
worry in imagery-based form.
Objectives and Methodology: High and low-worriers
performed a working memory task, random interval
generation, whilst thinking about a worry in verbal or
imagery form.
Results: High (but not low) worriers had less available
working memory capacity when worrying in verbal
compared to imagery-based form, demonstrating support
for the combined cognitive biases hypothesis (Hirsch,
et al. 2007). The findings could not be accounted for by
general attentional control, amount of negatively-valenced
thought, or appraisals participants made about worry
topics.
Discussion and Conclusion: The findings indicate that
the verbal nature of worry is implicated in the depletion
of working memory resources during worry among highworriers, and point to the potential value of imagerybased techniques in cognitive-behavioural treatments for
problematic worry.
EABCT 2012
Using Imagery in Cognitive Bias Modification for
Depression
Simon E. Blackwell1; Tamara J. Lang1; Catherine J.
Harmer1; Phil Davison1; Emily A. Holmes1
1
University of Oxford, United Kingdom
Introduction: Negative cognitive biases play a key role
in maintaining depression. Computerized “Cognitive
Bias Modification” (CBM) procedures designed to
train more positive biases may therefore have useful
clinical applications. A CBM paradigm that targets both
interpretation and imagery may be particularly powerful
in depression due to the potential interaction between
these processes (Holmes, Lang, & Deeprose, 2009).
An initial study of interpretation and imagery-focused
CBM for depression supported the importance of mental
imagery in enhancing the clinical benefits of the paradigm
(Blackwell & Holmes, 2010), but this required more formal
investigation.
Objectives and Methodology: The study presented
investigated whether mental imagery ability predicted
whether participants with depression benefitted from an
interpretation and imagery-focused CBM intervention.
Twenty-six currently depressed individuals were randomly
allocated to complete either positive imagery CBM or a
control condition daily at home over one week. Measures
of imagery ability were collected at baseline, and the
characteristics of participants who did or did not “respond”
to the CBM program compared.
Results: Amongst participants completing the positive
imagery CBM, those who demonstrated clinically
significant reductions in depression (“responders”)
scored significantly higher at pre-treatment on measures
of mental imagery compared to those participants who did
not (“non-responders”). Other baseline characteristics,
with the exception of gender, did not differ between
responders and non-responders.
Discussion and Conclusion: The implications for our
understanding of the potential role of mental imagery in
enhancing the clinical benefits of CBM for depression
are discussed. Future work needed to further elucidate
the interaction of imagery and interpretation in CBM for
depression are outlined.
39
8
S08-01
S08-02
Symposium
Symposium 8 - The combined cognitive bias
hypothesis in anxiety and depression:
Towards a comprehensive understanding
of cognitive vulnerability
Symposium
8
S08-03
S08-04
Biased Information Processing in Sad Mood
State: Attention, memory, and the Coherence
between Biases
Janna Vrijsen1; Iris van Oostrom1; Linda Isaac1; Eni S.
Becker1; Anne Speckens1
1
Radboud University Nijmegen Medical Centre, The
Netherlands
Introduction: Numerous behavioral studies have
examined mood congruent information processing in
several modalities like attention and memory. The cognitive
theories (Bower, 1981; Beck, 1976) assume a uniform bias
across modalities, but the empirical support for this claim
is less consistent than assumed.
Objectives and Methodology: In the present study,
we were interested in the effect of mood state on biased
information processing across different domains and
modalities, and particularly in the coherence between
biases. Two groups were created with half of the 360
participants assigned to the happy mood condition and
the other half to the sad mood condition. The Dot Probe
task with emotional facial stimuli, the Emotional Stroop
task with emotional words, and the verbal Incidental
Learning task with Free Recall phase were administered
to all subjects.
Results: Mood-congruent processing was found on the
Dot Probe task as well as on the Emotional Stroop task. The
Free Recall phase of the Incidental Learning task revealed
that individuals in a sad mood unexpectedly recalled less
negative and more positive words than individuals in a
happy mood, indicating a mood-incongruent memory
effect. This contrasts the mood-congruent encoding
phase finding. No significant correlations between bias
indices emerged. The subsequent PCA, however, showed
coherence between encoding of and attention for verbal
affective stimuli.
Discussion and Conclusion: Mood-congruent
processing was found on the Dot Probe task as well as on
the Emotional Stroop task, but not on the recall phase of
the memory task. The data further suggests that biases in
attention and memory do not share a common underlying
process; rather they seem distinct modality-specific
processes. If substantiated, this would mean that we cannot
unthinkingly regard the concept ‘biased processing’ as a
global susceptibility factor or even intermediate phenotype
for emotional disorders. Because biases are proposed to
be trait characteristics that may increase the susceptibility
to depression, we are currently examining the coherence
between biases in a large remitted depressed patient
sample.
Cascading Effects of Attention Bias on
Information-Processing in Dysphoria: A Path
Analysis Approach to examine the Combined
Cognitive Bias Hypothesis
Jonas Everaert1; Ernst H. W. Koster1; Wouter Duyck1
1
Ghent University, Belgium
Introduction: Guided by cognitive models of depression,
empirical research has yielded substantial data
demonstrating emotional biases in attention, interpretation,
and memory in depression. Although the past years have
seen an accumulative number of studies examining the
interplay between cognitive biases in depressed samples,
scientific understanding of how biased cognitive processes
are interlinked remains limited.
Objectives and Methodology: This study investigated
associations between attention, interpretation, and
memory biases in a mixed sample of dysphoric and nondysphoric individuals (N=71). Participants completed a
computerized version of the scrambled sentences test (i.e.,
interpretation bias measure) while their eye movements
were recorded (i.e. attention bias measure). This was
followed by an incidental free recall task (i.e. memory bias
measure).
Results: Results showed significant correlations between
depression levels, attention, interpretation, and memory
bias measures. To test specific hypotheses regarding
the interplay between cognitive biases, path analyses
compared models with and without mutual relations
among cognitive biases in a theory-driven manner.
Excellent model fits were revealed only for path models
including mutual relations (e.g., a cascade of attention
bias over interpretation bias on memory bias).
Discussion and Conclusion: The observed correlations
among bias indices provide support for the broader
construct of information-processing bias. Consistent
with predictions by cognitive accounts, results suggest
that biases rather operate in concert than in isolation.
Preliminary support is provided for a cascading effect
of attention bias on interpretation and memory biases.
Implications for future research are discussed.
40
EABCT 2012
Guided Internet-delivered cognitive behaviour
therapy for post-traumatic stress disorder: A
randomized controlled trial
Gerhard Andersson1,2; David Ivarsson1; Marie Blom1;
Hugo Hesser1; Pia Enderby1; Rebecca Nordberg1; Per
Carlbring3
1
Linköping University, Sweden; 2Karolinska Institute
Stockholm, Sweden; 3Umeå University, Sweden
A few previous studies have investigated the effects of
Internet-delivered CBT (ICBT) on symptoms of posttraumatic stress disorder (PTSD). The aim of the present
study was to investigate the effects of guided ICBT in
patients diagnosed with PTSD. Sixty-two participants with
PTSD as assessed by the Clinician-administered PTSD
Scale were recruited and randomized to either treatment (n
= 31) or to a wait-list control condition (n = 31). The CBT
treatment consisted of 8 weekly treatment modules covering
psychoeducation, breathing retraining, imaginal and in vivo
exposure, cognitive restructuring, and relapse prevention.
Therapist support and feedback on homework assignment
were given weekly via a closed secure contact handling
system. Assessments were made at baseline, post-treatment
and at one-year follow-up. Main outcome measures were
Impact of Events Scale - Revised (IES-R) and Post-Traumatic
Stress Diagnostic Scale (PDS). Results showed a superior
effect of the treatment regarding PTSD symptoms (between
group Cohen’s d on the IES-R d= 1.25 and on the PDS d
= 1.14), as well as reductions of depression and anxiety,
and improved quality of life. The results at one-year followup showed that treatment gains were maintained. In sum,
this result suggests that guided ICBT can be an effective
treatment option for persons with PTSD.
EABCT 2012
Cognitive Behaviour Therapy Delivered Face-ToFace With Support Via The Internet And An iPad
– A Standard Approach In The Future?
Kristoffer NT Månsson1, Per Carlbring2; Gerhard
Andersson1,3
1
Linköping University, Sweden; 2Umeå University,
Sweden; 3Karolinska Institute, Stockholm, Sweden
Introduction: Cognitive Behavior Therapy delivered
face-to-face (CBT) or via the internet with therapist
support (iCBT), has been evaluated in several randomized
controlled trials. Some advantages by delivering treatment
via the internet may be noted, such as availability in time
and space and standardized interventions. These benefits
would be interesting to use and inject into a traditional
CBT. We created a new web-based platform, accessible via
a computer or an Apple iPad. We included some standard
CBT content such as agenda setting, treatment goals and
a library containing information in purpose of giving
psychoeducation. The platform also contains an encrypted
message system, allowing for contact between sessions,
or contact replacing a therapy session due to impediment
or illness.
Objectives and methodology: A total of 15 participants
fulfilling any criteria of anxiety or depression according
to DSM-IV, was included in the study. 8 psychologists,
during their last term of the education, volunteered as
therapists. Therapy outcome measures that was used: Beck
Anxiety Inventory (BAI), Montgomery Asberg Depression
Rating Scale - Self Rated (MADRS-S), Patient Health
Questionnaire (PHQ 9), Generalized Anxiety Disorder
Screener (GAD 7), Quality Of Life Inventory (QOLI) and
Working Alliance Inventory (WAI). A qualitative interview
has been conducted to examine the experience of using
the support of internet, both as a patient and psychologist.
Results: A repeated measure and effect sizes (Cohen´s
d) are presented by each outcome measure, primary and
secondary. Post-treatment assessments was completed by
May 2012.
Discussion and conclusion: Both quantitative and
qualitative results will be discussed. A demonstration of
the web-based platform will be given.
41
9
S09-01
S09-02
Symposium
Symposium 9 - Internet based CBT:
Treatment outcome, therapeutic
alliance, therapist effects and iPad
supported face-to-face treatment
S09-03 Guided self-help for social anxiety
disorder: With and without an initial therapistled psycho-education session
Tine Nordgreen1, Thomas Haug1, Per Carlbring2, Gerhard
Andersson3, Odd E. Havik1
1
Haukeland University Hospital, Norway; 2Umeå
University, Sweden 3Linköping University & Karolinska
Institute, Sweden
Symposium
9
Introduction: Guided self-help via the internet based on
cognitive behavioral therapy (CBT) is established as an
effective treatment for social anxiety disorder. However, it
is not evident if increased therapist guidance initially will
increase treatment effects and decrease the drop-out rate.
Objectives and Methodology: The main objective of
the study was to examine if an initial therapist-led psychoeducation session (PE) would increase the treatment
effect and decrease the drop-out rate associated with
guided self-help for social anxiety disorder. A randomised
controlled trial was conducted in a mental health clinic for
university students. Six local therapists delivered the PE
and guidance during the self-help treatment.
Results: A total of 37 students were included in the study.
Outcome measurers include effect sizes on primary and
secondary outcomes and drop-out rates. Results between
the two groups are compared. Post-treatment assessment
was completed by February 2012.
Discussion: The clinical implications of the results will
be discussed.
S09-04
Does therapeutic alliance affect the treatment
outcome in tailored internet-administered
cognitive behavior therapy for anxiety disorders?
Lise Bergman Nordgren1, Per Carlbring2, Emma Linna1,
Gerhard Andersson2,3
1
Linköping University, Sweden; 2Umeå University,
Sweden; 3Karolinska Institute, Stockholm, Sweden
Internet-administrated cognitive behavior therapy (iCBT)
as a form of guided self-help has been found to be effective
for several conditions. Mostly this type of therapy is
restricted to target only one, specific, disorder. Tailoring the
treatment widens the scope of iCBT in that it can address
comorbidities directly. Therapeutic alliance, or working
alliance, has proven to predict outcome in several studies
on face-to-face therapy. To what degree these findings
is possible to generalize to iCBT is largely unknown an
the present study investigated if alliance measured at
pretreatment, and early in treatment (week 3) could predict
treatment outcome measured with the Clinical Outcomes
in Routine Evaluation – Outcome Measure (CORE-OM) in
42
a heterogeneous group of patients with anxiety disorders
(N=27). Results show that working alliance measured
at week three in treatment correlate significantly with
residualized change score on the primary outcome measure
(r=-.466, p=.019), while expected working alliance did
not. This result raise questions regarding the importance
of perceived working alliance in iCBT treatments, and
suggests that alliance could be as important factor in iCBT
as in regular face-to-face therapy.
S09-05
Internet-based cognitive behavior therapy for
generalized anxiety disorder: A randomized
controlled trial
Per Carlbring1, Andreas Håkansson1, Tomas Johansson1,
Magnus Pettersson1, Johan Sjögren1, Mats Dahlin1, Åsa
Kadowaki1, Gerhard Andersson1, 3
1
Umeå University, Sweden; 2Linköping University,
Sweden; 3Karolinska Institute, Stockholm, Sweden
As evident from several meta-analysis Internet-based
cognitive behaviour therapy (iCBT) with therapist support
has in numerous well conducted trials shown great
promise in the treatment of different anxiety disorders.
Even in the field of generalized anxiety disorder evidence is
emerging that iCBT can be a potentially effective treatment
option. However, many of these treatment programs can
be described as a static book on the internet. The large
number of pages that these programs sometimes are
comprised of can hypothetically be a barrier for patients
who are not used to reading books. To better fit individuals
without considerable reading experience a new, and more
interactive, web-based program was developed and tested.
After a diagnostic interview 100 participants, meeting
DSM-IV criteria for generalized anxiety disorder, were
randomized to either a 9-week treatment program or to an
active waitlist. The outcome measures were the Penn State
Worry Questionnaire, the Generalized Anxiety Disorder
Questionnaire-IV, the GAD-7, the PHQ-9, the Beck
Anxiety Inventory, the Montgomery Asberg Depression
Rating Scale, and the Quality of Life Inventory. Besides
pre and post measurements a weekly measurement was
also carried out using the GAD-7 and PHQ-9. Results
were analyzed on an intention-to-treat basis, including
all randomized participants. At the time of the conference
follow-up data will be available and presented. The
preliminary immediate results point in the direction of
large between group effect sizes. The clinical implications
of the results will be discussed and a quick demonstration
of the program will be made.
EABCT 2012
Long-term impact of the life goals group therapy
program for bipolar patients
Jean-Michel Aubry1; Aude Charmillot1; Nancy Aillon1;
Patrick Bourgeois1; Stefan Mertel1; Frédéric Nerfin1;
Gladys Romailler1; Marie-Joëlle Stauffer1; Marianne GexFabry1; Rachel Denis de Andrès1
1
Geneva University Hospitals, Switzerland
Introduction: Psychoeducation added to biological
treatment enhances overall effectiveness in bipolar
disorders. In the present study, we evaluated the longterm impact of a 2-phase structured psycho-educative
group program (Life Goals Program or LGP) for bipolar
patients, on parameters such as number and length of
hospitalizations, mood stability, relapse prevention and
social relationships.
Objectives and Methodology: Eighty-five patients (55
females, 30 males) with bipolar disorder (48 bipolar I,
37 bipolar II) were included retrospectively. Fifty patients
participated in phase 1 and 35 participated in phases 1&2
of the LGP. Impact on the number and cumulative length
of hospitalization was evaluated by comparing the 3-year
period before and after participation in phase 1 (6 weeks)
or phases 1&2 (median duration 24 months, range 3-74).
Results: Number of hospitalizations significantly
decreased from the 3-year period before to the 3-year
period after participation in phase 1 only (p=0.017), as
well as participation in both phases (p=0.035). After
attending phase 1 or phases 1&2, a majority of participants
reported subjective improvement in mood stability,
efficient prevention of relapse and better coping with
relapse. Perceived improvement of social relationships
was significantly higher for patients who attended phases
1&2 than for participants in phase 1 only. For a small
number of patients with severe recurrent episodes, group
psychoeducation had no impact on hospitalizations.
Discussion and Conclusion: Results suggest that
both phase 1 only and the full 2-phase LGP have longterm positive effects on the number of hospitalizations,
mood stability and relapse prevention. For patients not
responding to psychoeducation, cognitive remediation
could offer a better therapeutic approach.
EABCT 2012
Effects of psychoeducation and mindfulness in
refractory bipolar I disorder
Christine Mirabel-Sarron1; Aurélie Docteur1; Eryc SiobudDorocant1; Loretta Sala1; Dragana Goujon1; Philipp
Gorwood1,2; Frédéric Rouillon1,2
1
C.M.M.E., Paris Descartes University, Sainte-Anne
Hospital, France; 2INSERM U894, Sainte-Anne Hospital,
Paris, France.
Introduction: Efficacy trials suggest that structured
psychological therapies may significantly reduce
relapses in bipolar disorders. In 2006, Scott et al. found
no differences in recurrence rates of 253 refractory
bipolar I patients allocated to a CBT program in 12
sessions or to treatment as usual alone. However, Lam
et al. (2000) showed fewer bipolar episodes, with less
fluctuation in symptoms of mania and depression in
25 bipolar I patients allocated to a CBT program in 20
sessions.
Objectives and Methodology: In this original study,
with patients having higher comorbidities (i.e., anxiety
disorders, axis II personality disorders) than those of these
previous studies (Lam et al., 2000; Scott et al., 2006), we
assessed the efficacy of a 6-month CBT (Lam et al., 1999)
+ 2-month MBCT (Segal, Williams, & Teasdale, 2001) on
relapse prevention in 151 refractory bipolar I patients. We
included 188 bipolar I patients. Among them, 151 were
in intention to treat. 119 bipolar I patients participated to
a 20-week CBT. An 8-week MBCT was then proposed to
the CBT group patients. Among 103 patients who finished
the CBT program, 64 agreed to participate to a MBCT
approach, and 28 patients were in the waiting list group.
We assessed successively the efficacy of a CBT group
therapy and MBCT approach on relapse rates according to
several criteria: hospitalization, treatment adaptation and
symptoms severity (HDRS≥17).
Results: Main findings included: 1) A good acceptability
in bipolar I comorbid patients; 2) Excellent results on
relapse prevention; 3) Results all the more remarkable
that half of patients who will spontaneously engage in
MBCT were most severe in terms of duration of illness and
comorbidities.
Discussion and conclusion: CBT and MBCT showed
their efficacy in relapse prevention for complex bipolar I
patients. Longer follow-up assessments to estimate the
enduring effects of CBT and MBCT are required.
43
10
S10-01
S10-02
Symposium
Symposium 10 - Effectiveness of
psychological treatments for bipolar
disorder in three French speaking
countries
Symposium
10
S10-03
S10-04
Bipolar disorder maintenance treatment:
Contribution of Psychoeducation, CognitiveBehavioral Therapy (CBT) and MindfulnessBased Cognitive Therapy (MBCT)
Serge Beaulieu1; Nancy Poirier1; Sybille Saury1; Rébecca
Sablé1; Sagar Parikh1; Zindel Segal2
1
Douglas Mental Health University Institute, Canada;
2
University of Toronto, Canada
Introduction: Bipolar Disorders are associated with
greater stress reactivity and a larger prevalence of anxiety
disorders than the general population. Psychotherapies
are not only useful to teach self-control management
techniques but also to help with the prevention of
depressive and/or manic relapses. We will present
results from a study comparing group psychoeducation
to individual CBT, and we will also describe preliminary
results from MBCT studies.
Objectives and Methodology: A total of 204 participants
with Bipolar Disorder (BD) participated in a multi-center,
randomized controlled study evaluating the effectiveness
of 20 individual sessions of CBT compared to 6 sessions
of group Psychoeducation over 72 weeks. In a second
study, three pilot groups (n=28) on the feasibility of
MBCT in bipolar disorders were conducted at the Bipolar
Disorders Program of the Douglas University Institute for
Mental Health in Montreal. The goals of this study were to
assess the feasibility and safety of the approach for BD and
to test if MBCT might improve anxiety and sleep.
Results: Both individual sessions of CBT and group
Psychoeducation had similar outcomes with respect to
the reduction of symptom burden and the likelihood of
mood relapse over 18 months. In the second study, MBCT
proved to be well tolerated. Depressive symptoms as per
HAM-D-29 score slightly improved (Cohen’s d=0,35) from
pre-treatment compared to post-treatment. Psychic anxiety
was significantly decreased (Cohen’s d=0.88) at the end
of the treatment, especially when compared to somatic
anxiety. We also observed a trend toward an improvement
of sleep quality.
Discussion and Conclusion: Both individual sessions
of CBT and group Psychoeducation have substantial data
supporting a positive effect in reducing mood burden and
rates of relapse in bipolar disorder over the 18 month study
period. Furthermore, MBCT proved to be feasible and well
tolerated by patients suffering from Bipolar Disorder.
Psychological Treatments for Bipolar Disorder
and Impact on Comorbid Anxiety
Martin D. Provencher1; Philippe Baruch1; Julie StAmand1; Lisa Hawke1
1
Université Laval, Québec, Canada
44
Introduction: Comorbid anxiety disorders are frequent
in Bipolar Disorder and affect up to 75% of patients.
These comorbid disorders have a negative impact on
pharmacological treatment for bipolar disorder and
affect quality of life. Moreover, medications used to treat
anxiety might be harmful in some cases (e.g. increased
risk for manic switch or drug abuse/dependence)(ElMallakh & Hollifield, 2008). This has led several authors
to recommend psychological interventions for this
comorbidity (Provencher et al., 2011).
Objectives and Methodology: The goal of this
presentation is to review the effectiveness of psychological
interventions for bipolar disorder and their impact
on comorbid anxiety. Results of three studies will be
presented. All patients were treated at the Mood Disorders
Clinic of l’Institut universitaire en santé mentale de
Québec: 1) The impact of group psychoeducation for
Bipolar Disorder on comorbid anxiety; 2) The impact of
individual Cognitive-Behavioral Therapy (CBT) for Bipolar
Disorder on comorbid anxiety; and 3) The impact of CBT
for Generalized Anxiety Disorder (GAD) comorbid with
Bipolar Disorder as assessed in a single-case experimental
design.
Results: Results show that group psychoeducation
and CBT are effective in significantly reducing anxiety
symptoms as assessed by the Beck Anxiety Inventory.
Furthermore, CBT for GAD is also effective, with 3 out of
4 patients showing improvement on all outcome measures
and no longer meeting criteria for GAD.
Discussion and Conclusion: Results of these studies
show that group psychoeducation and CBT can be
effective in reducing comorbid anxiety symptoms in
Bipolar Disorder patients. Further studies will need to
assess the relevance and efficacy of these treatments in
larger samples.
EABCT 2012
Relevance is in the eye of the beholder:
Attentional bias to relevant stimuli in children
Suzanne Broeren1; Kathryn J. Lester2
1
Macquarie University, Australia; 2King’s College London,
United Kingdom
Introduction: Attentional biases are most often framed in
a threat-relevance framework. However, these frameworks
do not take into account that positive stimuli also seem
to attract attention. A novel theory that incorporates both
findings is the relevance/significance theory (Pessoa &
Adolphs, 2010; Purkis & Lipp, submitted). According to
this theory, the more relevant a stimulus is to a person,
the more rapidly it will be attended to. This framework,
contrary to the earlier evolutionary and modern threatbased theories of attentional bias, predicts that an
attentional bias will be present for all stimuli that are
relevant to a person, not only threat-relevant ones.
Objective: Until now, the relevance/significance theory
remains untested in children. In this talk, we will present
a first test of this theory in a sample of children aged 4 to
13 years.
Methods: Using a visual search task, we assess attentional
bias to evolutionary relevant threat stimuli (i.e. spiders,
angry faces); modern threat stimuli (i.e. guns, needles)
and positive, relevant stimuli (i.e. cake, gifts, happy faces)
in 358 children between age 4 and 13.
Results: Children not only displayed attentional biases
toward evolutionary and modern threat-related stimuli,
such as spiders and guns, but also to other relevant,
positive stimuli (i.e., cakes, gifts and happy faces).
Conclusions: These results suggest that attentional
biases are not specific to threat, but seem to apply to all
relevant stimuli, either positive or negative in valence,
providing first evidence for the stimulus relevance theory
of preferential attention in children
EABCT 2012
Temperamental Reactivity, Attention Bias to
Threat: A Developmental Perspective
Lauren White1, Nathan A. Fox1
1
University of Maryland, USA
Introduction: A substantial body of research exists
documenting associations between attention bias to threat
(ABT) and anxiety in children; however, little is known
about the factors that contribute to the development of ABT
and how ABT interacts with other developmental processes
to shape a child’s vulnerability to anxiety. One factor that
may influence the development of ABT and its relation to
anxiety is a child’s temperamental reactivity. Children with
a biological predisposition to respond with fear to threat or
unfamiliar stimuli in the environment may be more likely
to adopt an attention bias to threat. Additionally, ABT in
children with this temperament may lead to earlier onset
of anxiety symptoms.
Objectives: Using a longitudinal approach, the current
talk examines the role of behavioral inhibition (BI), a
temperament construct characterized by biological and
behavioral hypersensitivity to threat and the unfamiliar,
in the development of ABT. Additionally, interactions
between BI, ABT, and anxiety symptoms are examined.
Methodology: BI was assessed in the laboratory at 24
months of age and ABT and maternal-report anxiety were
assessed at 7-years of age (n=86).
Results: BI alone did not significantly predict ABT,
(F(1,84)=1.47, p=.23). Results revealed that ABT was only
related to anxiety problems in children with a history of BI
(t(76)=3.07, p=.003); ABT did not predict anxiety problems
in children with no history of BI, (t(76)= 0.14, p=.87).
Discussion and Conclusions: The current study
suggests that a child’s temperamental reactivity is an
important factor when examining links between ABT and
anxiety. While a history of BI does not appear to directly
influence the development of ABT, the presence of both
a temperamental predisposition to react negatively to
environmental stimuli coupled with ABT increase a child’s
risk for anxiety problems. Implications of the current
findings on the development of processing biases and
psychopathology will be discussed.
45
11
S11-01
S11-02
Symposium
Symposium 11 - Recent advances in
information processing biases in
childhood
Symposium
11
S11-03
S11-04
Comparing active and passive methods of
modifying interpretation biases about animal
situations in children
Kathryn J Lester¹; Ciara McClenaghan¹; Hadassa
Koorlander¹; Klaudia Pereira¹; Andy P Field²
¹King’s College London, United Kingdom; ²University of
Sussex, Brighton, United Kingdom
Introduction: Cognitive bias modification (CBM)
has recently been used to modify interpretation biases
in children. Adult CBM work suggests that asking
participants to actively generate and select the affective
meaning of ambiguity compared to providing the same
meaning passively may lead to larger effects, particularly
for mood. However, for children, the passive provision of
threat or positive verbal information (VI) can also affect
fear cognition and behaviour. The question remains
as to whether active or passive methods of modifying
interpretations are more effective in children.
Objectives & Methods: This talk compares an
active (CBM) and passive (VI) method of modifying
interpretations in 117 children aged 7-11 years. Children
received positive or negative CBM or VI training. During
CBM, children actively resolved the ambiguous situations
by selecting word fragments and answering questions.
For VI, children were presented with the same information
without resolving it for themselves. Pre- and post training
measures of interpretation bias and reduced evidence
for danger (RED) bias and mood ratings were collected.
Avoidance behaviour was assessed using a touch-box
stress task.
Results: Threat interpretations and RED bias increased
significantly across negative training and decreased
significantly across positive training. No effect of training
method (passive vs. active) was seen. The same pattern
was observed for anxious mood change. However,
negative VI was significantly more effective at increasing
anxiety than negative CBM. Negative training increased
behavioural avoidance relative to positive, with no effect of
training method. No significant effects were observed on
emotional reactivity to the stressor.
Conclusions: CBM and VI methods were equally effective
in modifying threat cognitions and avoidance behaviour.
Unlike the adult literature, passive VI training led to a
larger mood effects than active CBM, but only for those
assigned to negative training.
The neural signature of adolescent cognitive
reappraisals of emotion
Jennifer Lau1; Jessie Fu1; Catherine Campbell1; Belinda
Platt1;
1
University of Oxford, United Kingdom
Introduction: Negative interpretation of ambiguous
situations has been linked to adolescent anxiety. However
new data show that adolescents can be trained to use
positive interpretational styles, with improvements in
mood. Yet questions remain whether anxious adolescents
can be taught these strategies, and the neural mechanisms
by which training effects occur. As poor prefrontal cortex
(PFC) control over emotional responses characterises
anxious adolescents, interventions such as CBM may alter
activity in emotional brain circuits.
Objective: This talk assesses whether positive
interpretational styles can be trained in adolescents
selected for high anxiety (Study 1), and whether use of
these strategies activates PFC regions (Study 2).
Methods: Forty adolescents selected for anxiety
symptoms and 40 controls received either positive or
neutral CBM training. Pre- and post-training interpretation
bias questionnaires and mood ratings were collected. In
Study 2, 17 adolescents were trained to use cognitive
strategies to re-appraise emotional situations positively.
During MRI data acquisition, participants received
rejecting peer feedback and were instructed to use their
new skill to regulate mood. ROI analysis focused on
prefrontal activation during ‘re-appraisal’ (vs ‘attending’)
of rejecting stimuli.
Results: Only positively-trained adolescents selected
fewer negative interpretations of ambiguous vignettes
post-training (t(32)=2.81, p<.01), regardless of anxietygroup status. Mood changes were not apparent. In Study
2, significant activation in lateral and medial PFC was
found during re-appraisal.
Conclusions: All adolescents, including those who
scored highly on anxiety symptoms, can be taught to
interpret ambiguous situations positively. Regions of
the PFC may be implicated in the use of cognitive reappraisals to regulate emotions.
46
EABCT 2012
Considering the evidence for utilising CBT with
distressing voices: Problems and possibilities
Simon McCarthy-Jones1
1
Macquarie University, Sydney, Australia
This paper will begin by reviewing the evidence base for the
effectiveness of CBT for clients with distressing auditory
verbal hallucinations (AVHs). It will be concluded that at
present the evidence from randomised controlled trials of
CBT for AVHs is surprisingly weak. The various possible
reasons for this will be explored. These include, 1) the
existence of methodological limitations within existing
studies, for which improvements will be suggested, 2)
the existence of two subtypes of AVHs, each of which may
require different adaptations of CBT, and 3) that CBT for
AVHs not being sufficiently informed by what we know
about the causes of AVHs. To this end, the literature on
the causes of AVHs will be concisely summarised and
tentative suggestions made as to how the CBT toolkit may
be expanded in order to provide more effective help for
clients suffering from distressing voices.
S12-02
An investigation of adult attachment and the
nature of relationships with voices
Berry Katherine1
1
University of Manchester, United Kingdom
Background: Cognitive models of voice hearing propose
that distress arising from voices can be understood with
reference to the individual’s beliefs about voices, which
are, in turn, influenced by past and current relationship
experiences.
Aim: The study investigated associations between
attachment relationships and voice hearing. We
hypothesised associations between insecure attachment,
severity of voice hearing and distress in relation to voices.
We also hypothesised associations between attachment
and the nature of relationships with voices.
Method: Seventy three participants with a diagnosis of
schizophrenia spectrum disorders completed measures of
anxiety and avoidance in attachment relationships and we
coded experiences of voice hearing from interviews.
Results: There were modest but significant positive
associations between attachment anxiety and both
severity and distress in relation to voice hearing, but no
associations between attachment avoidance and these
EABCT 2012
S12-03
CBRT: Putting the ‘Relating’ into CBT for
distressing voices
Mark Hayward1
1
Sussex Partnership NHS Foundation Trust & University
of Sussex, United Kingdom
Cognitive models of auditory hallucinations are being
elaborated in an attempt to more fully understand the
variables that determine the distress often experienced
by hearers. There is a growing body of literature that
aims to explore the relevance of the concept of ‘relating’
to the experience of auditory hallucinations. Three
different theoretical perspectives have been utilized
in this respect: Benjamin’s Structural Analysis of
Social Behaviour; Gilbert’s Social Rank Theory; and
Birtchnell’s Relating Theory. Collectively, the use of
these theories suggest that the experience of auditory
hallucinations can be understood within interpersonal
frameworks, and the relationships that hearers develop
with their hallucinations share many properties with
interpersonal relationships within the social world.
This paper will focus upon one of the interpersonal
theories – Birtchnell’s Relating Theory – and offer
lessons learnt from qualitative and quantitative studies
that have informed our understanding of voices within
a relational framework. Issues of personification,
proximity and engagement are prominent, as is the
influence of relationships within the social environment
of the client. This paper will place a significant focus
upon the development of the therapeutic approaches
that have evolved from these understandings. Relating
Therapy and Cognitive Behavioural Relating Therapy
encourage clients to turn towards and learn about the
reciprocal processes that maintain the distress that
is often associated with hearing voices. Clients are
encouraged to take responsibility for their own relating
and to develop more assertive ways of responding
to the voices they hear. Two small case series have
suggested that these forms of therapy are acceptable
47
12
S12-01
dimensions. We found evidence of predicted associations
between attachment avoidance and themes of rejection,
criticism and threat in relationships with voices. Contrary
to predictions, there were no significant associations
between anxious attachment and the theme of control
in relationships with voices and no association between
anxious attachment and the theme of threat.
Conclusions: The study is promising in demonstrating
some associations between attachment and the nature of
relationships with voices. The assessment of attachment
styles may therefore be a useful contribution in developing
formulations of and treatments for voice hearing.
Symposium
Symposium 12 - CBT for distressing voices:
Lacking a relational perspective?
to clients and can be effective in modifying relating
variables and emotional responses, and these benefits
have been corroborated through stakeholder interviews.
The implications of these therapeutic developments will
be explored with reference to both clinical practice and the
future research agenda.
S12-04
Symposium
12
Changing relationship to distressing voices
through mindfulness practice
Clara Strauss1
1
University of Surrey, United Kingdom
Mindfulness has been defined as ‘paying attention in
a particular way; on purpose, in the present moment
and non-judgementally’ (Kabat-Zinn, 1994). This same
principle applies to mindfulness of voices - participants
are invited to pay attention to voices in the present moment,
on purpose and without judging voices or themselves as
good or bad (Chadwick, 2006). Participants are invited,
through verbal guidance, to bring awareness to current
experience, including voice comments. Just as with
mindfulness of thoughts of feelings (Segal et al, 2002),
participants learn to notice voice comments as transitory
events without inherent meaning.
Traditional cognitive therapy for distressing voices aims to
identify and evaluate beliefs about voices (Chadwick et al,
1996), particularly beliefs about voice control and power
(Birchwood & Chadwick, 1997). Through mindfulness
practice and the direct, non-judgemental and curious
attention to voice comments participants can develop new
metacognitive beliefs about voices (May et al, submitted).
In particular, through mindfulness practice, participants
can strengthen the belief that they have personal control
when voices are active (e.g. the ability to let go of an
unpleasant voice comment) and that voice comments are
not ‘facts’ (e.g. noticing voice predictions and threats that
do not come to fruition). In this way mindfulness practice
can be seen as an experiential way of developing a different
relationship to voices that can lend itself to change at the
metacognitive level.
This talk will focus on the theoretical foundations of
mindfulness for voices whilst having an experiential focus
for the audience. Evidence supporting the effectiveness
and acceptability of mindfulness for voices from our
research team will be drawn on whilst pointing the way
forward to future research questions.
48
S12-05
Interpersonal complementarity in responses to
voices: Reciprocal resistance and engagement
as targets for intervention
Thomas Neil1
1
Swinburne University, Melbourne, Australia
Introduction: Appraisals of auditory verbal hallucinations
(voices) are most frequently considered in terms of
perceptions of voices’ power and their malevolence–
benevolence. These appraisals each predict voice-related
distress. However, whilst cognitive therapy for voices can
successfully reduce perceived voice power, cognitive
interventions for the malevolence–benevolence dimension
have been less forthcoming. When conceptualised
interpersonally, these appraisals of voices map onto two
fundamental interpersonal dimensions of dominance–
submission and hostility–affiliation. A main application of
interpersonal theory is in understanding how certain types
of interactions tend to elicit complementary reactions. This
provides a framework for conceptualising responses to
voices, in particular responses to perceived malevolence–
benevolence.
Objectives and Methodology: The paper reviews
studies examining the relationships between malevolence/
benevolence appraisals and responses of resistance and
engagement measured with the Beliefs About Voices
Questionnaire, in combination with further data from
a study of 35 voice hearers who were administered a
measure of interpersonal relationships with their voices.
Results: In line with predicted complementary responses,
malevolence predicted resistance to voices and benevolence
predicted engagement. Likewise, in rated interpersonal
relationships with voices, perceived hostility vs. affiliation
predicted hostile vs. affiliative responses. Both resistant/
hostile and engagement/affiliative responses appear have
potentially negative consequences.
Discussion and Conclusion: Auditory verbal
hallucinations appear to elicit reciprocal interpersonal
responses. The ways in which these responses may
maintain the experience of auditory hallucinations and/
or contribute to distress will be discussed, leading to a
consideration of the therapeutic implications for helping
people to disengage from reciprocal responding to voices.
EABCT 2012
The Intolerance of Uncertainty Model revisited:
How do the model components relate to each
other?
Gioia Bottesi1; Sara Heary2; Helen Ham2; Rachel Peden2;
Mark H Freeston2
1
University of Padova, Italy; 2Newcastle University, United
Kingdom
Introduction: The Intolerance of Uncertainty Model (IUM)
for GAD identified four main components associated with
the development and maintenance of worry: Intolerance
of Uncertainty (IU), Negative Problem Orientation (NPO),
Positive Beliefs about Worry (PBW) and Cognitive
Avoidance (CA). Among them, IU was conceptualized as
a background factor and the literature of the last 20 years
supports the notion of IU as a vulnerability factor for worry.
Despite studies showing the contributions of NPO, PBW
and CA and occasionally in a mediational path from IU
to worry, their specific contribution still remains to be
clarified.
Objectives and Methodology: The aim of the present
study was to re-examine the IUM. We first tested whether the
path from IU to worry is mediated by the other components
of the model and then whether IU also moderates the
mediation. Mediation and moderated mediation models
were tested using bootstrapping approaches. Onehundred and one undergraduate students participated and
completed self-report questionnaires assessing worry,
somatic anxiety and the model components.
Results: Mediation analysis revealed that NPO and PBW
but not CA mediate the association between IU and worry.
Furthermore, moderated mediation analysis showed
that IU also moderates the effects of the indirect path
through NPO and PWQ on worry. The same analyses were
performed to examine the relationship between IoU and
somatic anxiety: NPO and CA but not PBW emerged as
significant mediators, and the indirect path was moderated
by IoU.
Discussion and conclusion: Present findings highlight
the distinct mediational role or indirect effects played by
NPO, PBW and CA in the path between IU and worry and
somatic anxiety. Moreover, they suggest that IU also acts
as a moderator, so there are conditional indirect effects for
two of the three components on each of worry and somatic
anxiety. These findings support the original model, but
provide a better conceptual integration of its components.
EABCT 2012
A hierarchical model for the relationships
between general and specific vulnerability
factors and symptom levels of generalized
anxiety disorder
Colin van der Heiden1
1
Erasmus University Rotterdam, The Netherlands
Introduction: Some authors have referred to GAD as
the “basic anxiety disorder”, suggesting that a better
understanding of the etiological factors for GAD may also
increase our knowledge about the origins of other (anxiety)
disorders. As to the etiology of GAD, it has been proposed
that the general vulnerability factor of neuroticism plays a
prominent role. However, little is known about the precise
mechanisms by which neuroticism exerts its influence on
specific syndromes. The examination of such mechanisms
can be justified because their identification might lead to
the development of more effective treatment methods.
The present study examined a hierarchical model for the
relationships between general and specific vulnerability
factors and symptom manifestations of generalized anxiety
disorder (GAD).
Method: A clinical sample of patients with GAD (N =
137) completed a set of self-report questionnaires for
measuring neuroticism, extraversion, intolerance of
uncertainty, metacognitive beliefs, and symptoms of
generalized anxiety (i.e., worry) and depression.
Results: Support was found for a model in which
the relation between the general vulnerability factor of
neuroticism and symptoms of GAD were mediated by the
specific vulnerability factors of intolerance of uncertainty
and negative metacognitions.
Discussion: Results support a hierarchical model
of GAD that serves as a descriptive framework for
understanding this anxiety disorder, and may provide a
basis for developing more specific treatments for GAD that
not only target the main symptoms of this disorder, but
also the specific processes that underlie them. As such,
the model supports the appropriateness of two recently
developed cognitive-behavioral treatments for GAD, based
on the metacognitive (Wells, 1995) and the intolerance of
uncertainty (Dugas & Ladouceur, 2000) accounts of this
specific disorder.
49
13
S13-01
S13-02
Symposium
Symposium 13 - Intolerance of
uncertainty: Diagnostic specific origins
and transdiagnostic future
Symposium
13
S13-03
S13-04
Intolerance of Uncertainty: Is there more of it in
GAD, or is it also present in other disorders?
Pablo Romero Sanchiz1; Aurora Gavino Lazaro1; Antonio
Godoy Avila1; Raquel Nogueira Arjona1
1
University of Malaga, Spain
Intolerance of Uncertainty (IoU) has received a great deal of
attention since it was proposed by the Laval team as a key
part of their model of Generalized Anxiety Disorder (GAD).
However this construct has also been linked to other
disorders, especially to Obsessive-compulsive Disorder
(OCD). Thus, although originally a putative specific factor
for GAD, it may also be important in understanding other
disorders. This presentation examines the association of
Intolerance of Uncertainty (IoU) and other linked cognitive,
emotional and behavioural variables (measured with
Cognitive Intrusions Questionnaire-Revised) with worry/
generalized anxiety disorder as well as features of health
anxiety and social anxiety among a non-clinical sample
(N = 200) and three clinical samples (GAD, 34; Health
Anxiety, 32; and Social Anxiety, 21). The results show that
IoU and other linked cognitive constructs like “Importance
of thoughts” and “Positive beliefs about thoughts”,
emotions like worry and anxiety in response to intrusions
and behavioural variables like “look for consolation”
are significantly higher in clinical samples than in nonclinical samples. Furthermore, IoU and other constructs
related to the Laval model of GAD are also higher among
GAD patients than in patients with Social Phobia and
Health anxiety. Results are discussed from a dimensional
perspective that allows us to examine the position of
each sample on hypothetical axes. This perspective goes
further than the mere differentiation between samples,
showing that, although the mean scores of each sample
are significantly separated, important portions of the
samples share overlapping space in the hypothetical
continuums. This has implications from both a diagnostic
and therapeutic perspective.
Intolerance of uncertainty and related factors in
adolescents with anorexia nervosa
Anna Konstantellou1
1
King’s College London, United Kingdom
Introduction: Individuals with anorexia nervosa (AN)
are cognitively rigid, dislike change, show an excessive
need for control and frequently have comorbid anxiety.
Despite this, anxiety related vulnerability factors, such as
intolerance of uncertainty (IU), have received little attention
in the field of eating disorders.
Objectives and Methodology: To present a conceptual
model of IU in AN and the results of a quantitative study
that examines IU and associated factors in adolescents
with anorexia nervosa and in their parents. Forty three
adolescents with AN and 22 healthy adolescent controls
(HC) completed self-report questionnaires on anxiety
related vulnerability factors, worry, anxiety, beliefs about
having AN and eating psychopathology. Fifty-nine parents
also completed similar self-report questionnaires.
Results: Adolescents with AN showed significantly
elevated levels of IU and other anxiety related vulnerability
factors when compared to HC. Most importantly,
differences between the two groups remained for IU even
when levels of anxiety were taken into account. Strong
positive correlations were also found between IU and
eating psychopathology, and positive and negative beliefs
about having AN. IU further emerged as a strong predictor
of eating psychopathology. Finally, parental reports
confirmed elevated levels of IU in their children.
Discussion and Conclusion: Findings support that
anxiety and eating disorders share similar vulnerability
factors. IU, in particular, is an important factor in
adolescents with AN possibly contributing to eating
psychopathology, positive beliefs about AN and elevated
need for control. Further research is needed to understand
better the role of IU in terms of symptom maintenance and
treatment outcome.
50
EABCT 2012
Cognitive errors, depressive symptoms and
treatment outcome: A study using an observerrated method for the assessment of cognitive
errors
Kelly Stelmaszczyk1; Keith S. Dobson1; Martin Drapeau1
1
McGill University, Montreal, Canada
Introduction: Cognitive behavioral therapy (CBT) for
Major Depressive Disorder is based on the rationale that
individuals suffering from depression possess negative
cognitions about themselves, their world, and their future.
Such negative cognitions are the result of systematic errors
in reasoning and are therefore referred to as cognitive
errors. Previous work has shown a relationship between
the frequency of cognitive errors and various indicators of
psychopathology, poor use of coping strategies and poor
overall mental health (Furlong & Oei, 2002; Miranda &
Mennin, 2007). A shortcoming of these studies is that they
were based on pre-post therapy questionnaires and did
not examine how cognitive errors displayed within therapy
relate to general functioning.
Aim: The current study examined how cognitive errors
and coping strategies are related to psychopathology,
namely major depression, and to treatment response using
two observer rated methods designed to assess cognitive
errors (Drapeau et al., 2007) and coping behaviours (Perry
et al., 2005) as they are used or reported by patients within
therapy sessions.
Method: Data were collected as part of the landmark
component study conducted by Jacobson and colleagues
(1996, 2008). Of the participants, (n=150), fifty were
randomly assigned to a manualized CBT group and were
used for analysis in the current study. Transcripts from
therapy sessions at two time points (the beginning and
end of treatment) were assessed using validated observer
rating scales to measure patient use of cognitive errors
and coping patterns. These measures were then compared
to scores from the Beck Depression Inventory, the
Hamilton Depression Scale, and the Global Assessment of
Functioning Scale, which were completed by patients both
before and after therapy.
Results: Significant associations were found between
use of specific cognitive errors, symptoms and
general functioning. Results also indicated significant
relationships between coping strategies and symptoms. A
number of these findings are contrary to current cognitive
EABCT 2012
S14-02
Coping action patterns and depression: A pilot
study of depressed inpatient undergoing a brief
psychodynamic psychotherapy
Yves de Roten1; Ueli Kramer1; Emilie Chappuis1; Martin
Drapeau2; Jean-Nicolas Despland1
1
University of Lausanne, Switzerland; 2McGill University,
Montréal, Canada
Introduction: Researchers are still confronted with
a high degree of uncertainty about the processes of
change in psychotherapy. One major issue concerns the
distinction between processes that are unique to CBT or
psychodynamic psychotherapy and processes that are
common to both forms of psychotherapy.
Objectives and Methodology: This pilot study aims
at documenting this question by examining change
in coping and depression with brief psychodynamic
psychotherapy. A subsample of n = 15 patients who
responded to a manualized Inpatient Brief Psychodynamic
Psychotherapy (Ambresin, de Coulon & Despland, 2009)
were selected from an RCT. Two sessions (the second and
the penultimate) were rated for coping using the Coping
Action Patterns (Perry et al., 2005). A weighted meanscore was computed, referred to as the Overall Coping
Functioning (OCF).
Results: Consistent with previous findings with CBT
(Drapeau et al., 2010), results showed that (1) at intake,
depression was associated with more behavioral coping
and less cognitive coping; (2) OCF increased significantly
over the course of BPI; and (3) improvement in depression
was associated with less use of opposition and more
problem solving. Links with therapeutic alliance was also
examined.
Discussion: These results are discussed with regard to
the significance of coping as a common change process
in different psychotherapy approaches.
51
14
S14-01
behavioural theory. Furthermore, a significant relationship
between flexibility in coping and mental health was found.
Discussion: Implications for treatment and research will
be discussed. The value and importance of not relying
only on questionnaires but of also using observer rated
methods will also be discussed.
Symposium
Symposium 14 - Cognitive errors and
coping action patterns as in-session
manifestations in depressive and
personality disorders: Advances using
process-based methodology
Symposium
14
S14-03
S14-04
Biased thinking assessed by external observers
in borderline personality disorder
Cynthia Vaudroz1, Ueli Kramer1, Ornella Ruggeri1; Martin
Drapeau2
1
University of Lausanne, Switzerland; 2McGill University,
Montréal, Canada
Introduction: Biased thinking (to some extent overlapping
with the concepts of cognitive distortions and cognitive
errors) is a key concept in cognitive therapy of Borderline
Personality Disorder (BPD). Specific contents and cognitive
processes related to BPD functioning are known. However,
most studies are based on self-report measures which
present a number of important limitations, in particular the
difficulty in assessing nonconscious processes infused
by affect. So far, no studies were conducted using valid
observer-rated methodology addressing the question of
biased thinking in BPD as it unfolds spontaneously in
session.
Objectives and Methodology: The aim of the present
study was to apply a valid oberver-rated system of cognitive
errors from the process perspective to standardized clinical
interviews eliciting relevant schemas conducted with
patients presenting BPD and to compare their cognitive
error profiles with the ones of matched healthy controls.
A total of N = 25 clinical dynamic interviews with patients
presenting with BPD were transcribed and rated using the
Cognitive Errors Rating Scale (Drapeau, Perry, & Dunkley,
2008); their cognitive profiles were compared to those of N
= 25 healthy controls who underwent the same procedure.
Results: Overall, results indicated that no betweengroup difference in the frequency of specific biases was
found. However, heightened levels of negative cognitive
biases, in particular over-generalizing and fortune-telling,
were associated with BPD. Furthermore, negative overgeneralizing was associated with the number of BPD
symptoms.
Discussion and Conclusion: These results have high
levels of ecological validity and are promising for the
refinement of cognitive theory of BPD. Clinical implications
for assessment and intervention are discussed.
Change in cognitive errors over the course of ten
sessions of clinical management in borderline
personality disorder
Hasnia Abdellaoui1; Ueli Kramer1
1
Institute of Psychology, University of Lausanne,
Switzerland
52
Objectives: Cognitive errors are now recognized as
characteristics of Borderline Personality Disorder (BPD), and
several models postulate cognitive change over the course of
psychotherapy. More specifically, this study assumes change
in negative cognitive errors related to the clinical evolution.
Design: This is a treatment study comparing the same
group of BPD patients before and after a clinical management
over ten sessions (Gunderson & Links, 2008). Results are
compared to the clinical evolution.
Methods: A total of N = 40 therapy interviews with N
= 20 patients presenting with BPD (both intake and one
later-in-process sessions for each) were transcribed and
rated using the Cognitive Errors Rating Scale (Drapeau,
Perry, & Dunkley, 2008); their initial cognitive profiles
were compared to their final ones, and the difference is
compared to the clinical evolution, rated on the Outcome
Questionnaire (Lambert, Gregersen & Burlingame, 2004).
Results: Results indicate change in cognitive errors
patterns over the course of clinical management, in
particular a decrease of negative cognitive errors and in
specific sub-categories, such as fortune-telling and overgeneralizing. Lower levels of negative cognitive errors and
in particular in over-generalizing were associated with the
clinical evolution.
Conclusions: These results provide a better understanding
of the cognitive mechanisms in BPD, and suggest clinical
implications for the treatment of BPD.
EABCT 2012
Belief-confirming reasoning bias in social
anxiety disorder: Baseline effects and changes
over the course of treatment
Maartje Vroling1; Klaske Glashouwer1; Wolf-Gero Lange1;
Esther Allart1; Peter J. de Jong2
1
Radboud University Nijmegen, The Netherlands;
2
University of Groningen, The Netherlands
Introduction: Social anxiety disorder patients have a
remarkable persistence in their dysfunctional convictions:
Even though they have experienced many situations in
which they were not negatively evaluated, they are still
convinced that their convictions are true. Even though
they have oftentimes for instance not been ridiculed
when blushing, they remain convinced that showing a
blush in public will result in being ridiculed. This leads
to the question whether social anxiety disorder patients
are capable of drawing correct conclusions when given
evidence: Are these patients able to disentangle what they
believe from what is true given the evidence presented.
Method: In a first study using an analogue design this
capability was investigated. Participants were presented
with syllogisms that were either logically valid or invalid,
and either believable or unbelievable.
Results: It was found that all participants (high and low
anxious) have a difficulty to disentangle believability from
logical validity. Yet, participant high on social anxiety
complaints showed a similar difficulty when reasoning
with social anxiety related information, while this bias was
absent in non-anxious participants.
Discussion: It may well be that the difficulty to disentangle
what one believes from what is objectively true is a
maintaining factor in social anxiety disorder, as it hinders
the falsification of dysfunctional convictions such as ´if I
blush, than people will ridicule me´. In a follow-up study,
we tested whether this effect could be replicated in a social
anxiety disorder patient sample. Also, we tested how this
reasoning bias changes over the course of CBT treatment.
In addition, we studied whether residual reasoning bias is
predictive of relapse. Results from these studies will be
discussed.
EABCT 2012
Dealing with other’s emotions: The hindering
effects of social anxiety
Corine Dijk1
1
University of Amsterdam, The Netherlands
Introduction: Socially anxious (SAs) core fear is that they
will be evaluated negatively by others. Sadly, this indeed
happens. Various studies have shown that others judge
SAs as less friendly, assertive, relaxed, comfortable and
intelligent, are less likely to desire future interactions with
SAs and perceive SAs as being less similar. An important
question is why this social rejection occurs. One of the
mechanism that might play a role is the finding that SA
often experience abnormalities in their emotions in social
situations, such as too much stress and anxiety. From a
social-functional perspective, a key function of emotions
is to coordinate an individual’s social interactions and
relationships.
Objectives and Methodology: Two studies will be
presented that aimed to gain more insight in the role of
inadequate emotional processing of SAs as a cause of
this social rejection. The first study tested SAs reactions
towards short clips of emotion expressions. The second
study tested SAs reactions to emotional expression in an
actual social interaction.
Results: Both studies showed that SA do mimic these
expressions. Nevertheless, study one showed that they
experience more negative emotions and are somewhat
impaired in recognizing the other’s expressions. Also,
results indicate that they might try to over-regulate their
facial expressions.
Discussion and conclusion: Implication of these
results for understanding the social anxiety-social
rejection relation as well as its clinical implications will
be discussed.
S15-03
Socially anxious get a second chance after being
disliked at first sight: The role of self-disclosure
in the development of likeability in sequential
social contact
Marisol Voncken1
1
Maastricht University, The Netherlands
Introduction: Socially anxious individuals (SAs) not
only fear social rejection but accumulating studies
show evidence for the social anxiety – social rejection
relationship.
Objectives: This study investigates the very first
impression of SAs. The study further investigates the
53
15
S15-01
S15-02
Symposium
Symposium 15 - Explicit and implicit
behaviors in social anxiety
Symposium
15
development of their likeability and the role of selfdisclosure herein in two sequential social interactions.
Method: High (n=24) and low (n=22) female SAs were
rated on first impression after a few seconds. Their
likeability and various self-disclosure behaviours were
rated after a 5 minutes ‘waiting room’ situation and a
‘getting acquainted’ conversation.
Results: High SAs elicited a more negative first impression
than low SAs and were rated as less likeable after both
interactions. The level of self-disclosure behaviour was
the strongest predictor for the development of likeability
during the sequential social tasks. Furthermore, in the
getting-acquainted task with the same level of selfdisclosure behaviour the high SAs were even liked more
than the low SAs.
Discussion: This suggests that high SAs can improve
their negative first impression by increasing their selfdisclosure behaviour. However, SAs also showed a
decreased level of self-disclosure behaviour during both
social interactions.
Conclusion: Thus, targeting self-disclosure behaviour
could improve the negative impression SAs elicit in others
and help to repair their negative social interaction cycles.
S15-04
Automatic Avoidance of (Emotional) Faces and
Symptoms of Social Anxiety
Peter de Jong1
1
University of Groningen, The Netherlands
Introduction: Socially anxious individuals tend to avoid
social situations that may give rise to negative evaluation.
Avoidance behavior is considered a major factor in the
maintenance of social anxiety. Although avoidance is
typically conceptualized in terms of voluntary behavior,
there is increasing evidence that subtle and automatic insituation avoidance may play an important role in social
phobia. Such subtle avoidance may be especially relevant
for social anxious individuals, as complete avoidance of
social situations is impossible.
Objective: The present study was set out to examine
whether indeed such more automatic tendency to avoid
rejecting faces and/or a reduced tendency to approach
happy faces are involved in social anxiety.
Methods: We introduced a computerized ApproachAvoidance Task (AAT) in a large prospective population
study (N= 1816) among adolescents (Tracking Adolescents’
Individual Lives Survey-TRAILS). The AAT comprised of
happy, angry, disgusting, and neutral faces, and non-face
control stimuli. Participants were instructed to respond as
fast as possible by pulling or pushing a joystick on the
basis of the color filter. For each expression, automatic
approach-avoidance tendencies were indexed by the
54
difference in RT between pushing and pulling a particular
type of expression. We investigated whether social anxiety
is characterized by emotion-specific AAT effects, and
whether this relationship is specific for social anxiety
or represents a more general characteristic of people
suffering from internalizing disorders.
Results: We just finished the data-acquisition.
Discussion: Results and theoretical implications will be
discussed.
Conclusion: If indeed results will show that automatic A-A
tendencies are associated with social anxiety symptoms,
an important next step would be to experimentally reduce
AA-tendencies to test its alleged role in the persistence of
symptoms.
S15-05
Does automatic avoidance of facial crowds
change during the therapy of Social Anxiety
Disorder?
Wolf-Gero Lange1; Maartje Vroling1; Klaske Glashouwer1;
Esther Allart1; Mike Rinck1; Eni Becker1
1
Radboud University Nijmegen, The Netherlands
Introduction: Cognitive models suggest that highly
socially anxious individuals (SAs) tend to interpret/
evaluate social cues such as facial expressions in a
negative/threatening way. It has been shown that SAs
impulsively avoid angry and smiling faces. As these
kinds of biases are thought to play a maintaining if not a
causal role in social anxiety, it is crucial to investigate in
how far they respond to therapy and whether they may be
indicative for relapse.
Objective: The present study investigated if biased
behavioral impulses in response to face presentations
change during psychotherapy.
Methods: Patients with a diagnosis of social anxiety
disorder and age, education and gender-matched controls
were asked to respond to different ratios of neutral–angry,
neutral-happy, or neutral-disgusted face combinations
(crowds). In an indirect Approach-Avoidance Task,
participants used a joystick to pull the crowds towards
themselves (approach) or push them away (avoidance).
Avoidance as reflected in speeded push- or slowed pullmovements was assessed before, directly after and 6
month after CBT treatment.
Results: The data-collection was just completed.
Discussion: Results and implications will be discussed.
Conclusion: If approach-avoidance tendencies proof to be
immune to therapy or if the reduction of these tendencies
is predictive for relapse after therapy, it is evident that, if
possible, these behavioral impulses should be specifically
targeted in therapy.
EABCT 2012
Magneto-encephalographic (MEG) brain
recordings during traumatic memory recall in
women with post-traumatic stress disorder: A
pilot study
Jean Cottraux1
1
Ifforthecc (Institut Francophone de formation et de
recherche en thérapie comportementale et cognitive) and
University Lyon, France
Background and objectives: The objective was to
study the effects of traumatic memories with magneto
encephalography (MEG).
Methods: A tape-recorded voice administered a scriptdriven imagery test to nine right-handed female volunteers
with DSM-IV PTSD. They had to imagine, successively, a
neutral image (N), a traumatic memory (T) and a resting
state in a safe place (R), while MEG measured brain
activities across four bands: delta (1-4 Hz), theta (4-8 Hz),
alpha (8-13 Hz) and beta bands (13-30 Hz). The taperecording specified the current instruction and asked the
patients to concentrate on each mental image for three
minutes, while remaining silent and keeping the eyes
closed. Heart rate (HR), anxiety and the vividness of mental
images were also recorded. For MEG power analysis, the
signals were averaged for each of the three conditions. The
dependent variable was a subtracted value: (Trauma - Rest)
- (Neutral - Rest). The p was set at p< 0.01.
Results: Anxiety and HR significantly increased during
the T condition and returned to the N level during the R
condition. The vividness of the mental imagery remained
stable across the three conditions. MEG analysis found
a significant power decrease in the left secondary visual
cortex, left insula, left premotor cortex, and Broca area.
Limitations: We used a within-group design and included
only women.
Conclusions: This is the first study to provide MEG data on
trauma recall along three minutes, showing that traumatic
memories may inhibit brain regions related to language
and emotion regulation
EABCT 2012
Virtual Reality Exposure Therapy for Anxiety
Disorders
Charles Pull1,2; Marc Dammé1, Marie-Claire PullErpelding2, Lidwine Wouters2, Maxime Larcelet1
1
Laboratoire des Troubles Emotionnels, Centre de
Recherche Public Santé, Luxembourg ; 2Clinique
des Troubles Emotionnels, Centre Hospitalier de
Luxembourg, Luxemnourg
The main component of cognitive-behavioural therapy for
anxiety disorders is graded exposure to the feared stimuli.
Exposure may be performed in imagination, in vivo or in
virtual reality. Virtual reality integrates real-time computer
graphics, body tracking devices, visual displays, and
other sensory input devices to immerse a participant in a
computer generated virtual environment that changes in a
natural way with head and body motion. In the treatment
of anxiety disorders, virtual reality exposure therapy or
VRET is currently used to expose patients to virtual people
(avatars), animals (e.g. spiders), or situations (e.g. heights).
Exposure using VRET has several advantages compared
with conventional exposure therapy: (1) safety: the patient
can be exposed to the feared situations with a high degree
of safety; (2) flexibility: exposures can be easily adapted to
individual fear hierarchies; (3) confidentiality: the exposure
takes place in the privacy of the therapist’s office; and (4)
cost: the treatment is less time-consuming. The authors
will describe major techniques of VRET and review results
obtained with VRET in anxiety disorders. In addition, they
will report on results obtained in two personal studies, the
first a multi-centre randomized controlled trial comparing
exposure in imagination to VRET in patients suffering from
Panic disorder with Agoraphobia, and the second a singlecentre randomized controlled trial comparing exposure in
imagination to VRET in subjects with fear of flying.
55
16
S16-01
S16-02
Symposium
Symposium 16 - New technologies in CBT
implementation, evaluation and teaching
S16-03
Symposium
17
An e-learning interactive teaching program for
CBT
Philippe Champy1
1
Editis (Grupo Planeta) Retz, France
Retz, a pedagogical publishing house, has decided with
its partner Ifforthecc to release CBT e-learning resources
on health market. The project came from the common
desire to provide a specific and standardized CBT
training program for mental health professionals. Digital
interactive resources are powerful tools for professional
skills acquisition and improvement. The design of this
new program is outlined: 22 CBT modules with a repetitive
architecture, going from theory to practice. This includes
author’s video-interventions to announce each step of the
learning frame, slides, voice-over, dynamic illustrations,
interactive conceptual or memory exercises (quiz), PDF
documents downloading, and short videos presenting the
therapist-patient interaction at the different stages of the
therapy. In conclusion will be presented a first analysis of
the e-learning program impact on different categories of
health institutions and professionals.
S16-04
Cardiac variability use in stress reduction
Charly Cungi1
1
Ifforthecc, France; Clinique Belmont, Switzerland
Heart Rate Variability (HRV) allows an evaluation of
autonomic nervous system (ANS) activity, especially the
parasympathetic one. Physiological reactions are related
to stress and emotions and strongly correlated with HRV.
HRV is decreasing when the stress response is significant,
and increasing when parasympathetic activity becomes
predominant. The recording, moment to moment, of those
HRV fluctuations can be transformed into a biofeedback
of ANS functioning. Moreover, this re information loop
allows both the patient and the therapist to evaluate the
effectiveness of stress reduction methods.
This communication presents four clinical examples of
HRV use to optimize a stress reduction program. It is new
low-cost and easy-to-use biofeedback method. Practical
management of the heart-math equipment is detailed.
HRV represents a tool to treat stress-related physical and
psychological conditions related to anxiety
56
Symposium 17 - Anxiety and Fear
Conditioning: Modern insights on
brain, genes and the role of individual
differences
S17-01
Single-dose dopaminergic agonism unties
extinction memories from the extinction context
and prevents the return of fear
Jan Haaker1; Tina Lonsdorf1; Nina Gartmann1; Fabio
Morellini1; Raffael Kalisch
1
University Medical Center Hamburg-Eppendorf (UKE),
Germany
Traumatic events can engender persistent and debilitating
fear responses to trauma reminders. Post-traumatic fear
may return even after successful treatment, making relapse
prevention a major challenge for therapy. In the laboratory
analog of behavior therapy, extinction, conditioned fear
responses (CRs) are diminished using repeated exposure to
the conditioned stimulus (CS) in the absence of the aversive
unconditioned stimulus (UCS) with which it had previously
been paired. Extinction does not erase the conditioned fear
memory (CS-UCS association) but generates a competing
extinction memory (CS-noUCS association) that is however
tied to the context in which extinction occurred. Accordingly,
a dominance of fear over extinction memory retrieval and,
thus, return of fear are mainly observed if the extinguished
CS is encountered outside of the extinction (therapy) context.
Dopamine has been implicated in long-term potentiation
(in particular late-LTP) and long-lasting memory
consolidation processes, and first data suggest that
dopamine antagonism impairs extinction memory
consolidation. We show that one-time administration of
the dopamine precursor L-DOPA directly after extinction
learning, i.e., during the extinction memory consolidation
phase, makes extinction memories context-independent,
thus strongly reducing return of fear (spontaneous recovery,
reinstatement, renewal). Generalization of extinction was
observed in both mice and healthy human volunteers. In
mice, L-DOPA significantly reduced freezing-measures of
spontaneous recovery and reinstatement of contextual fear
when tested 30 days after extinction. In humans, L-DOPA
attenuated CS-related activation of the amygdala (cued
fear) and of the bed nucleus of the stria terminalis (BNST)
(contextual fear) 1 week after extinction, as measured
using functional magnetic resonance imaging (fMRI). In a
second human study, L-DOPA reduced the renewal of cued
fear in skin conductance and fear ratings tested 1 day after
extinction. This was accompanied by attenuated amygdala
activation and lesser deactivation of the ventromedial
prefrontal cortex (vmPFC). The short half-life of L-DOPA
excludes acute effects during testing phases.
EABCT 2012
Inter-individual differences in acquisition and
extinction of conditioned fear
Sonja Römer1; Tanja Michael1
1
Saarland University, Saarbrücken, Germany
Introduction: The present study examines why some
people develop anxiety disorders after threatening events,
whereas others do not. In particular, it aims to investigate
the relationship between inter-individual differences
in personality traits and conditioned fear responses in
a laboratory setting. As previous research has mainly
focused on risk factors, we have looked whether certain
traits (e.g. resilience) act as protective factors.
Methodology: Healthy participants underwent a
differential fear conditioning experiment. A highly
annoying but not painful electrical stimulus severed as
the unconditioned stimulus (US) and two neutral pictures
were used either as the paired (CS+) or the unpaired
(CS) conditioned stimulus. The experiment consisted of
4 phases: habituation, acquisition, extinction, and test of
extinction memory 24 h later. Conditioned fear responses
were primarily quantified by skin conductance responses
(SCRs), assessed during every CS-presentation.
Participants filled out standard questionnaire measures
of resilience, coping strategies with stress, as well as
self-efficacy and locus of control before conducting the
conditioning procedure. Correlations between these
questionnaires and skin conductance responses were
calculated.
Result: Results (N=40) suggest that resilience is negatively
associated with skin conductance responses (acquisition:
rCS+=-.37). The same was true for high self-efficacy
(habituation: rCS+=-.39, rCS-=-.42; acquisition: rCS+=-.44;
extinction: rCS-=-.38; extinction memory: rCS+=-.47, rCS=-.64). On the contrary, maladaptive coping-strategies
with stress (intake of pharmaceuticals) were associated
with stronger skin conductance responses (habituation:
rCS+=.51, rCS-=.36; acquisition: rCS+=.50; extinction memory:
rCS+=.36, rCS-=.40).
Discussion and Conclusion: The results suggest that
some personality traits (e.g. resilience) act as protective
factors against acquiring a strong fear response after an
aversive event, whereas others (e.g. maladaptive coping
strategies with stress) put individuals at risk for acquiring
strong fear responses.
EABCT 2012
The effects of noradrenergic blockade on
extinction
Marieke Bos1; Tom Beckers2; Merel Kindt1
1
University of Amsterdam, The Netherlands; 2University of
Leuven, Belgium
Introduction: Recent insights in the neurobiological
basis of fear reduction resulted into the development of
novel approaches for enhancing treatment efficacy for
anxiety disorders. Pharmacological adjuncts to facilitate
extinction learning or to disrupt reconsolidation of fear
memory have shown to successfully reduce the expression
of fear in the long-term. However, the possible limitations
of these procedures are still largely unknown.
Objectives: Here, we investigate a potential boundary
condition of disrupting reconsolidation with the
noradrenergic antagonist propranolol in humans.
Reconsolidation can be initiated by retrieval of an acquired
fear memory, which is in procedure equivalent to extinction
training. So, if memory retrieval (i.e., unreinforced CS
presentation) promotes the formation of a novel extinction
memory trace, propranolol may interfere with extinction
rather than with the reconsolidation of fear memory.
Methodology: Thirty healthy volunteers participated
in a three-day differential fear conditioning procedure,
consisting of acquisition (day 1), non-differential
extinction (repeated memory reactivation; day 2),
differential extinction and reinstatement testing (day3). On
day 2, participants were randomly assigned to a placebo or
propranolol condition.
Results: The results yielded no evidence for direct
interference of propranolol with extinction at a physiological
level (startle reflex and skin conductance). Critically,
at a cognitive level (CS-US expectancies) propranolol
immediately impaired extinction learning. Moreover, the
impairment in declarative extinction learning remained for
24h.
Conclusion: These findings emphasize that if we are to
target reconsolidation with pharmacological agents to treat
patients with anxiety disorders, careful selection of timing
parameters is essential to ensure that pharmacological
agents interfere with the intended memory process to
reduce fear.
57
17
S17-02
S17-03
Symposium
Our data identify a new molecular player in human extinction
memory consolidation and open new perspectives for
pharmacological enhancement of psychotherapy. L-DOPA
might be particularly useful in relapse prevention.
Symposium
17
S17-04
S17-05
The effect of counterconditioning on evaluative
responses in fear conditioning
An Raes1
1
Ghent University, Belgium
Introduction: In fear conditioning, extended extinction
successfully targets harm expectancy as well as the fear
response, but it often fails to eradicate the negative affective
value that is associated with the conditioned stimulus.
Objectives and Methodology: In this line of studies,
we examine whether counterconditioning can serve to
reduce evaluative responses within fear conditioning.
Undergraduate students are subjected to a differential
conditioning procedure in which one stimulus
(conditioned stimulus; CS+) is repeatedly paired with
a threatening stimulus (unconditioned stimulus; US),
whereas another stimulus (CS-) is presented unpaired.
After acquisition, one third of the sample is allocated to
an extinction procedure. The other participants receive
counterconditioning with either a neutral stimulus or
with a positive stimulus. Explicit (subjective ratings) and
implicit (startle blink reflex, affective priming) measures of
evaluative responding are taken.
Results:
Preliminary
findings
suggest
that
counterconditioning, in contrast to extinction,
successfully reduces evaluative responses. This result
applies to both counterconditioning with positive and
neutral stimuli. Furthermore, only implicit, not explicit
measures of evaluative responding are influenced by
counterconditioning.
Discussion: The available data suggest that
counterconditioning procedures might be a promising
approach in diminishing evaluative learning in fear
conditioning. However, further research is needed to
examine the mechanisms underlying this effect. The
finding that pairing the CS+ with a neutral stimulus also
reduces evaluative learning suggests that reduction of
uncertainty, rather than changing the valence of the CS+
might underlie the success of counterconditioning.
Conclusion: Residual evaluative responses contribute
to return of fear after extinction. The present research
indicates that counterconditioning can be a successful
approach in targeting these evaluative responses.
Personality Risk Traits Influence Associative
Fear Learning
Femke Gazendam1; Jan Kamphuis1; Merel Kindt1
1
University of Amsterdam, The Netherlands
Introduction: Individual variability in fear learning is often
ignored in experimental fear learning studies. However,
several lines of research suggest that stable individual
differences moderate the vulnerability for developing
anxiety disorders. These traits may provide a window for
understanding how initially adaptive fear associations
evolve into pathological fears.
Objectives and Methodology: We used Multilevel
Growth Curve Modeling to examine how personality
traits associated with emotional disorders, affect the
acquisition, extinction and generalization of fear. Study 1
included 243 students who participated in one of several
differential fear conditioning studies conducted in our lab.
We also present preliminary findings from study 2, which
uses a representative adolescent sample from the normal
population (N = 1000). On the basis of previous theoretical
and empirical work, we selected Stress Reaction (SR) and
Harm Avoidance (HA) as lower order personality variables
of interest, as well as their corresponding higher order
factors Negative Emotionality (NEM) and Constraint (CON)
(Multidimensional Personality Questionnaire; Tellegen &
Waller, 2008; Eigenhuis, Kamphuis, & Noordhof, in press
for the Dutch version). Conditioned fear responding was
indexed by the fear-potentiated startle reflex (study 1 and
2), skin conductance responses, and subjective distress
ratings (study 2).
Results & Conclusions: Self-reported personality
ratings were associated with differential fear learning
parameters as indexed by psychophysiological and
subjective measures. Our preliminary findings suggest
that a premorbid personality characterized by high Stress
Reaction and high Harm Avoidance (and corresponding
high NEM and high CON) may predispose individuals
towards a dysfunctional fear learning pattern, characterized
by elevated initial reactivity (fear-potentiated startle),
subsequent impaired discrimination of fear and safety, and
a persistence of fear reactivity when threat ceases.
58
EABCT 2012
Physiological blushing in social anxiety disorder
(SAD) patients with and without blushing
complaints: Two subtypes?
Marisol J. Voncken1; Susan M. Bögels2
1
Maastricht University, The Netherlands; 2University of
Amsterdam, The Netherlands
Introduction: A considerable proportion social anxiety
disorder (SAD) patients develop a blushing phobia.
Although the capacity to blush is a characteristic of normal
human functioning, individuals differ in their blushing
propensity and intensity. One of the etiological markers of
the development of SAD could be vulnerability for more
frequent and/or intense blushing. However, studies so far
have produced conflicting results.
Objectives and methodology: The study that will be
presented investigates whether SAD patients with blushing
complaints show heightened physiological blushing
and arousability in social situations compared to SAD
patients without blushing complaints and healthy controls.
SAD blushers (n = 32), SAD non-blushers (n = 34), and
healthy controls (n = 25) conducted two social tasks. The
physiological responses cheek and forehead blood flow,
cheek temperature, and skin conductance were recorded, as
well as confederates-observed blushing.
Results: The SAD blushers showed more physiological
blushing (cheek temperature and blood flow) than SAD
non-blushers and observers detected this difference. This
finding was also present in comparison to the controls,
except for blood flow. For blood flow SAD blushers and
controls did not differ but SAD non-blushers showed
a ‘suppressed response’: a smaller cheek blood flow
increase during the interaction and no recovery compared
to the other groups. Furthermore, on skin conductance no
differences between groups were observed.
Discussion and conclusion: The extent to which SAD
blushers and SAD non-blushers represent two qualitative
distinct subgroups of SAD and the implications this has
for treatment will be discussed.
S18-02
Fear of Blushing: The Role of Attributing
Relatively Restrictive Standards to Others
Peter J. de Jong1; Corine Dijk2; Madelon Peters3
1
University of Groningen, The Netherlands; 2University of
Amsterdam, The Netherlands; 3Maastricht University, The
Netherlands
EABCT 2012
S18-03
Attention for bodily symptoms and external
social cues in speech anxiety
Alexander L. Gerlach1; Desirée Deiters1; Stephan Stevens2
1
University of Cologne, Germany; 2University of Giessen,
Germany
Introduction: Cognitive models of social phobia propose
that socially anxious individuals engage in heightened
self-focused attention. Evidence for this assumption was
provided by dot probe and feedback tasks measuring
attention and reactions to proxies of bodily symptoms
such as blushing, trembling or sweating. However, it is
unclear whether similar patterns of attentional processing
can be revealed while participants actually engage in a
social situation.
59
18
S18-01
Symposium
Symposium 18 - Socially anxious’ fear of
bodily symptoms: Causes and cures
Introduction: Recent evidence indicates that blushing
fearful individuals not only overestimate their blushing
intensity but also de facto blush more easily and intense
in common social situations. It has been argued that this
may result from a biased judgment about the need for
social appeasement. This perspective points to two critical
features that may jointly set people at risk for a heightened
tendency to blush: a relatively high sensitivity to other
people’s judgment and a tendency to attribute relatively
restrictive social standards to other people (e.g., about
what is appropriate and what is not). There is already
ample evidence that people with fear of blushing are
relatively sensitive to other people’s judgments.
Objectives: In two subsequent studies we tested the
proposed tendency of blushing fearful individuals to also
attribute relatively restrictive social standards to other
people.
Methods: Study 1 relied on a non-clinical sample (N=63)
with varying levels of fear of blushing. Study 2 replicated
this study in a treatment seeking sample of blushing fearful
individuals (N=30) and a nonfearful control group (N=30).
Participants read descriptions of common behaviours, and
were asked to indicate (i) to what extent they considered
this behaviour as violating prevailing standards, and
(ii) their expectation of the impact of displaying such
behaviours on the observers’ evaluation.
Results: Both studies consistently showed that
individuals’ level of blushing fear was indeed associated
with the tendency to attribute relatively restrictive social
standards to others, and to anticipate relatively negative
social evaluations.
Discussion and conclusion: These findings are in
agreement with the idea that a biased judgment about
the need for social appeasement is involved in blushing
phobia. It also provides some relatively unexplored
starting points for the treatment of blushing phobia.
Symposium
18
Objectives and Methodology: The current study used
a new paradigm, simultaneously measuring attention to
bodily symptoms and external stimuli in anticipation of
and during a speech task. Participants with speech anxiety
and nonanxious controls were asked to press a button in
response to external or internal probes, while giving a
speech on a controversial topic in front of an audience. The
external probe consisted of a LED attached to the head of
one spectator and the internal probe was a light vibration,
which ostensibly signaled changes in participants bodily
symptoms.
Results: The results indicate that during speech
anticipation, high speech anxious participants responded
significantly faster to internal probes than low speech
anxious participants, while during the speech no
differences were revealed between internal and external
probes.
Discussion: This is the first study providing experimental
evidence for a heightend self-focused attention in a social
situation. Arguably, our results also provide evidence that
external social information is not preferentially processed,
at least in speech anxious individuals.
Conclusions: Our results provide support for the pivotal
role of self-focused attention towards bodily symptoms
in anticipatory anxiety. Furthermore, they provide a new
framework for understanding interaction effects of internal
and external attention in anticipation of and during actual
social situations.
S18-04
Efficacy of Intensive Group Therapy for Social
Anxiety Disorder with Fear of Blushing – A
Randomized Controlled Trial
Samia Chaker1; Jürgen Hoyer1
1
Technical University Dresden, Germany
Introduction: The size and burden of mental health
problems require a broader access to short, cost-effective
and evidence-based treatments. Social anxiety disorder
(SAD) with fear of blushing is probably underdiagnosed,
although empirically validated treatments exist.
Objective and methodology: We examined the efficacy
of intensive group therapy for SAD with fear of blushing
comparing Task Concentration Training (TCT), cognitivebehavioral therapy according to Clark and Wells (CBT),
and wait-list in a randomized controlled trial (N = 82).
Intensive group treatment consisted of two weekends with
either TCT on the first weekend plus CBT on the second or
CBT first plus TCT. Reductions in fear of blushing and in a
Social Phobia Composite were defined as primary outcome
criteria. Six- and 12-month follow-up assessments were
made.
Results: TCT and CBT were both superior to wait-list and
60
equally effective after the first therapy weekend. Adding
the second weekend led to further improvement (Cohens
d > 1.12) and high response rates (> 44%). No differences
were found between the sequences TCT-CBT and CBT-TCT.
At the 6-month follow-up, remission rates in completers,
established by diagnostic status, were between 69 and
73%. Results remained stable at the12-month follow-up
in the TCT-CBT condition while in the CBT-TCT sequence
further improvements occurred.
Discussion and Conclusions: TCT and CBT applied
in an intensive group therapy setting are highly effective
in treating SAD with fear of blushing and lead to stable
improvements. The intensive group format specifically
designed for patients sharing a common primary concern
may contribute to the dissemination of CBT.
S18-05
Dealing with Fear of Blushing: A
Psychoeducational Group Intervention for Fear of
Blushing
Corine Dijk1; Femke M. Buwalda2; Peter J. de Jong3
1
University of Amsterdam, The Netherlands; 2In huis:
knowledge of psychological health, Maarssen, The
Netherlands; 3University of Groningen, The Netherlands
Introduction The clinical impression is that people
who fear blushing do not easily seek psychological
help for their complaints. Therefore, we designed a low
threshold psychoeducational group intervention to reduce
fear of blushing. The intervention followed a cognitive–
behavioural approach, but in a course setting, e.g., with
‘participants’ and ‘teachers’ instead of ‘patients’ and
‘therapists’.
Objective and methodology: The effectiveness of the
course in reducing fear of blushing and social anxiety was
tested in a group of blushing fearful individuals (N=47) by
using an uncontrolled study design. The course consisted
of six weekly sessions and one booster session 3 months
after the last regular session. Assessments took place
upon application, immediately before the intervention,
after the sixth session, before the booster session, and at
1 year follow up.
Results: Results showed that the course was effective in
reducing fear of blushing as well as symptoms of social
anxiety.
Discussion and conclusions: The positive effect of the
course on anxiety measures suggests that it might be a
promising approach for treating fear of blushing.
EABCT 2012
Recovery informed CBT for bipolar disorder:
Progress with an early intervention trial
Steven Jones1; Lee Mulligan1; Gina Smith1; Mary
Welford1; Anthony Morrison1
1
Lancaster University, United Kingdom
Objective: Recovery in mental health typically involves
individual personal change in which the development of a
new sense of self can lead to the establishment of a fulfilling
and meaningful life, whether or not symptoms are present.
Individuals’ perspectives on recovery in bipolar disorder
(BD) are important but have received little attention from
researchers. This talk will consider why the popularity of
recovery approaches amongst mental health consumers
has not yet significantly influenced care delivery in bipolar
disorder. In this context the presentation will describe a
new measure of recovery in bipolar disorder, report on
a new recovery informed CBT intervention for bipolar
disorder (RfCBT) and describe progress with an RCT
evaluation of this intervention.
Method: A new Bipolar Recovery Questionnaire (BRQ)
was developed based informed by prior qualitative
research and feedback from mental health consumers,
clinical and academic experts. This was evaluated in 60
individuals with bipolar disorder prior to implementation
in RfCBT. Recovery informed CBT for bipolar disorder:
68 individuals with SCID diagnosis of bipolar disorder
received within the last 5 years were recruited and
randomised to receive either RfCBT plus treatment as
usual or treatment as usual alone
Results: BRQ is supported by adequate initial psychometric
data and rational relationships with measures of current
symptoms, functioning and appraisal RfCBT has been
developed in consultation with consumers to focus on
enhancing recovery and quality of life outcomes. The
structure of the therapy and progress with recruitment and
retention will be reported
Conclusions: Recovery is widely discussed amongst
consumers but therapy approaches in bipolar that
specifically facilitate recovery are lacking. Our work
to date indicates that recovery themes can inform new
therapy developments. Implications of our work for clinical
practice will be discussed.
EABCT 2012
Bipolar Intervention Study: Cognitive
Interpersonal Therapy (BIS:CIT): The feasibility
and acceptability of CIT in early Bipolar Disorder
Jamie Kirk1
1
Glasgow University, United Kingdom
Objectives: The study aimed to assess the feasibility of
recruiting a sample of participants early in the course of
Bipolar Affective Disorder (BP) to a randomised control
trial of Cognitive Behavioural Therapy. We aimed to
randomise participants within 12 months of a first or
second treated episode of mania and/or hypomania.
Methods: We aimed to establish recruitment,
randomisation and assessment of outcome amongst
individuals who had experienced their first or second
treated episode of mania and / or hypomania in the
previous 12-months prior to study entry. We assessed
symptoms of depressed mood, mania or hypomania over
a variable monthly follow-up of between 3 to 8 months
dependent on the date of entry to the study. In addition,
global assessment of functioning and perceived social
support was assessed on a monthly basis.
Results: A total of 20 participants were randomised to the
study. CBT was acceptable amongst those randomised to
the experimental treatment. We noted suggestive trends to
indicate CBT may be associated with improved wellbeing
and depression.
Implications: Further research is required to establish
further research parameters including effect size, sample
size, competence to deliver treatment, evaluation of health
economic outcomes, and proposed mechanisms of change
61
19
S19-01
S19-02
Symposium
Symposium 19 - CBT for bipolar disorders
S19-03
Symposium
19
Increasing access to evidence based
psychological therapy in bipolar disorder:
Potential benefits of staff training, group CBT
and online therapy
Fiona Lobban1; Richard Morris1, Steven Jones1
1
Lancaster University, United Kingdom
Objectives: Effective psychological interventions are only
useful if people are able to access them outside of research
trials and specialist centres. Helping people with Bipolar
Disorder to understand what triggers their mood changes
and how to recognise and manage early warning signs of
relapse is effective in increasing time to relapse, reducing
hospitalisation, and improving functioning. The problem
is that many people do not access this kind of intervention.
Developing a range of effective ways to deliver this support
to increase accessibility and offer choice is crucial. This
presentation will present data on intervention trials to
evaluate 3 different approaches: training frontline care staff
to offer a brief relapse prevention program (ERP); group
psychoeducation co-facilitated by health professionals and
service users; an online Enhanced Relapse Management
(ERM) programme for people with bipolar disorder and
their relatives. The pros and cons of these approaches will
be discussed.
S19-04
The perils and promises of exercise for people
diagnosed with Bipolar Disorder
Kim Wright1; Tamsin Armstrong1; Adrian Taylor1; Sarah
Dean1; Emma Everson-Hock2
1
University of Exeter, United Kingdom; 2University of
Sheffield, United Kingdom
The application of physical activity (PA) as an intervention
for individuals with depression has been accompanied by
calls for PA to be prescribed to individuals with Bipolar
Disorder. This talk reviews the evidence base for the use
of PA as a means of improving physical or mental health
amongst people with Bipolar Disorder, concluding that
there is little information upon which to draw conclusions
about the safety and efficacy of PA as an intervention in
this population, and to guide the development of such
interventions. The present talk presents the findings of two
studies that seek to begin to address this deficit. In the
first, 25 individuals with a diagnosis of Bipolar Disorder
provided information upon their exercise habits and
participated in a semi-structured interview concerning
their views on the relationship between PA and Bipolar
Disorder. The data were subjected to qualitative analysis
62
using an Interpretative Phenomenological Analysis (IPA)
approach. The analysis revealed several novel themes
that provide new information about the way in which PA
may be experienced by individuals with Bipolar Disorder.
In the second, relationships suggested by this qualitative
research were explored quantitatively in a separate sample.
The findings are discussed in terms of their implications
for the use of PA as a means of improving health in
individuals with Bipolar Disorder.
S19-05
Interpersonal Psychotherapy Therapy (IPT)
treatment for young people with bipolar affective
disorder: A pragmatic randomised control trial
Matthias Schwannauer1
1
University of Exeter, United Kingdom
In this paper we are going to present the development
and efficacy of IPT for adolescents with bipolar disorders.
Community studies have shown a point prevalence
of 1 to 2% for bipolar disorders and recent studies are
showing suicide to be one of the chief cause of death in
young people. Clinical and epidemiological data have
documented that bipolar disorder and recurrent mood
difficulties in adolescents are a largely underrecognised
underserved population. The undertreatment of
adolescents with bipolar disorders, including limited
access to appropriate psychological therapies, can be
explained by a combination of their limited access to and
underutilisation of mental health care. The implementation
and evaluation of IPT as treatment that is regarded by
adolescents as «more immediately relevant» must be an
objective for anyone aiming to better meet the needs of this
vulnerable group.
In this presentation we will highlight the development of
a bespoke practice model of IPT-A for young people with
bipolar disorder, considering key features of adolescent
development in the treatment manual. The paper will
present results of a pragmatic RCT of IPT for adolescents
with bipolar disorders. The session will focus on the
application of the IPT model to bipolar disorder and
present the outcome of a randomised trial in the Child and
Adolescent Mental Health Services in Lothian, Scotland,
examining the effects of treatment on core symptoms,
coping styles and interpersonal problems. The results
showed clear improvement in core symptomatology and
quality of life for following intervention.
EABCT 2012
The Comprehensive Inventory of Mindfulness
Experiences (CHIME): Construction and
validation
Claudia Bergomi1, Wolfgang Tschacher1, Zeno Kupper1
1
University of Bern, Switzerland
During recent years mindfulness-based approaches have
been gaining relevance for treatment in clinical populations.
As the empirical study of mindfulness has steadily grown,
the availability of valid measures of the construct is
critically important. Several authors have pointed to the
fact that current mindfulness scales produced unexpected,
problematic results (e.g. systematically different response
patterns in subsamples differing in age and meditation
experience; positive associations with measures of
symptom load and dissociation in individuals without
meditation experience) and thus have called into question
the validity of self-report measures of mindfulness. A new
mindfulness self-report measure, the Comprehensive
Inventory of Mindfulness Experiences (CHIME), will be
presented. The coverage of aspects of mindfulness in the
CHIME is based on a review of the aspects of mindfulness
assessed by eight available mindfulness questionnaires.
Analysis based on the first version of the CHIME (N = 313)
suggest that a non-avoidant stance plays a central role in
mindfulness, while the capacity to put inner experiences
into words may be related to mindfulness rather than a
component of the construct. This latter scale was thus
dropped. The final version of the CHIME was validated
in a community sample (N=298) and a sample of MBSR
group participants (N=161). Factor-analytical procedures
supported an eight-factor structure. The questionnaire
and its subscales exhibited satisfactory reliability, good
construct, criterion and incremental validity as well as
change sensitivity. Analyses of measurement invariance
suggested that the interpretation of the CHIME’s items does
not systematically differ across groups differing in gender,
meditation experience and symptom load. Moreover,
even in a subsample of individuals without meditation
experience the CHIME did not show problematic patterns
of association within its subscales nor with measures
other measures.
EABCT 2012
Behavioural measure of mindfulness: Reliability
and validity of the 3 Minute Mindfulness Test
Ivan Nyklicek1, Jenny van Son1
1
Tilburg University, The Netherlands
Introduction: Mindfulness is paying attention to the
present moment in an accepting way. Several interventions
are based on enhancement of mindfulness. Self-report
instruments for mindfulness assessment have been
criticised.
Objectives: Therefore, the aim was to examine the
reliability and validity of a new behavioural measure of
mindfulness: the 3 Minute Mindfulness Test (3MMT).
It consists of verbally expressing one’s momentary
experiences, including thoughts, for three minutes during
resting.
Methodology: Thirty-five experienced meditators and
forty-seven control participants matched on age and
sex performed the 3MMT and completed the Five Factor
Mindfulness Questionnaire (FFMQ) and the Balanced
Index of Psychological Mindedness (BIPM). Responses
were coded by two independent coders. Based on these
categories, four indices of mindfulness were computed:
Interoceptive Mindfulness, Exteroceptive Mindfulness,
Judgmental Attitude (reversed) and Meta-Cognition.
Results: Because of too few cases of Judgmental Attitude,
Meta-Cognition, and several single cell categories, these
were omitted from analyses. Intraclass correlations between
the two raters were .85 for Interoceptive Mindfulness and
.80 for Exteroceptive Mindfulness. As expected, the only
significant correlation with self-reported mindfulness was
between Exteroceptive Mindfulness and FFMQ Observe (r
= .24, p = .03). Interestingly, Interoceptive Mindfulness
correlated with psychological mindedness (r = .35, p =
.002). Compared to controls, meditators scored higher
on both Interoceptive Mindfulness (F[1,80] = 13.60, p <
.001, partial eta2 = 0.15) and Exteroceptive Mindfulness
(F[1,80] = 5.66, p = .02, partial eta2 = 0.07).
Conclusion: The 3MMT provides a behavioural measure
of mindfulness that (a) taps into aspects of mindfulness
which are not captured by self-report instruments, (b)
yields reliable scores, and (c) shows content and predictive
validity. Its use in clinical trials to examine changes during
mindfulness-based interventions is recommended.
63
20
S20-01
S20-02
Symposium
Symposium 20 - Mindfulness Assessment
and Clinical Research
Symposium
20
S20-03
S20-04
The Necker Cube paradigm as an indirect way to
assess mindfulness
Niko Kohls1-4, Sebastian Sauer1, Jana Lemke2-4, Marc
Wittmann3, Ursula Mochty5, Harald Walach2-4
1
Ludwig-Maximilians-Universität Munich, Germany;
2
Viadrina University, Frankfurt, Germany; 3Institute
for Frontier Areas in Psychology and Mental Health,
Freiburg, Germany; 4Brain, Mind, and Healing Program,
Samueli Institute, Alexandria, USA; 5University of
Tübingen, Germany
Process research in Mindfulness Based
Cognitive Therapy for Depression (MBCT) using
the Daily Mindfulness Questionnaire
Zeno Kupper1; Claudia Bergomi1; Maija Dundure1; Angela
Lanz1; Wolfgang Tschacher1
1
University of Bern, Switzerland
Objectives: Mindfulness based cognitive therapy for
depression (MBCT) has shown to effective for the reduction
of depressive relapse. However, research on mechanisms
and processes of change during MBCT remains scarce.
Processes of changes regarding mindfulness and changes
in depression specific patterns such a cognitive reactivity
to mood swings have rarely been researched. To address
these issues, in this study processes of change during
MBCT were recorded using a novel instruments and
analyzed with both qualitative and quantitative approaches.
Methods: A newly developed self-report measure (Daily
Mindfulness Scale, DMS) was applied daily during the
MBCT program. The self-reports included an assessment
of mood and mindfulness on the given day as well as
questions regarding personal goals and achievements.
Additionally, subject filed a short daily qualitative report
of experience and mindfulness practice. 50 patients
from MBCT groups were included in this study. These
approaches allowed for single case studies of processes
during MBCT, multiple time-series analyses using the
daily mood and mindfulness rating, as well as for an
analysis on a group level.
Results: Results suggest that the quantitative and
qualitative measures used were congruent. Qualitative
data suggested that a nonjudging attitude toward the
mindfulness exercises and an increased transfer to
day-to-day behavior was related to greater effect sizes
in depression related measures, such as dysfunctional
attitudes and residual symptoms. The assessments
allowed analyzing typical change processes during MBCT.
Time series analysis aggregated on group level revealed
significant changes, suggesting a change in cognitive
reactivity.
Conclusions: The assessment methods and analysis
strategy used in this study seem both feasible in clinical
practices and a promising approach to a more precise
understanding of the processes of change during MBCT.
The experience of the present moment is characterized by
an integrative neuronal mechanism that fuses successive
events into a unitary phenomenological experience with a
temporal limit of about three seconds. It is well known that
this time frame may be altered as a consequence of neuronal
or psychopathological disorders. However, an interesting
question is if mind-body techniques may actually be
able to extend this time window. We hypothesized that
proficiency of mindfulness expands the ability to stabilize
an ambiguous percept in a bistable image paradigm using
the Necker Cube, and that this effect is associated with
individual differences in the level of mindfulness. Expanded
duration of nowness as indicated by the ability to stabilize
a bistable image stimulus for a longer period of time may
improve cognitive resources and thus be of practical and
clinical interest. In a sample of N = 38 meditators and N
= 38 non-meditators, meditators showed longer duration
of subjective nowness. This effect was associated with
individual mindfulness levels. It is concluded that the
subjective now can be longer for meditators than for
non-meditators, and individual levels of mindfulness
may convey this effect. We hypothesize that this ability
is particularly associated with the presence component
of mindfulness and that this experimental paradigm may
therefore potentially be utilized as an indirect measure of
the presence component of mindfulness.
64
EABCT 2012
Background: Depression is a common co-morbidity
of diabetes, negatively affecting physical performance,
glycemic control, adherence to medication, and dietary,
and exercise recommendations. Although Mindfulnessbased cognitive therapy (MBCT) has been found to be an
effective program in decreasing psychological symptoms
in a variety of populations, it may in clinical practice not
always be feasible to offer or participate in the group
program. This randomized controlled trial examined
diabetes patients’ acceptability of individual MBCT
(I-MBCT) and its immediate effects on levels of depressive
symptoms, distress, and mindfulness.
Methods: Twenty four diabetes patients with elevated
levels of psychological symptoms were randomized to
an 8-week I-MBCT course (n=12) or waitlist (n=12). Both
groups completed written questionnaires at baseline and
three months later. Intention-to-treat analyses are reported.
Results: Patients receiving I-MBCT reported significantly
greater reductions in depressive symptoms (F (1, 22)=
12.95, p = .002) and diabetes-specific distress (F (1, 22)=
10.21, p = .004) and greater improvements in mindfulness,
compared to controls. Overall, patients were satisfied with
the program and evaluated most exercises as useful.
Discussion: This is the first RCT on the effects of individual
MBCT on depressive symptoms. The study, although
based on a small underpowered sample and therefore
preliminary, suggests that I-MBCT is an acceptable and
effective intervention in reducing psychological symptoms
in diabetes patients. The results support future larger
randomized controlled studies aimed at examining the
efficacy of this promising variant of MBCT.
EABCT 2012
S21-01
Aufmerksamkeits-und Gedächtnisbias für
Essensreize bei der Binge Eating Störung
Jennifer Svaldi1; Eva Naumann1; Florian Schmitz2
1
Universität Freiburg, Germany; 2Universität Ulm,
Germany
Hintergrund:
Empirische
Untersuchungen
zu
Aufmerksamkeits- und Gedächtnisverzerrungen haben
zu einem besseren kausalen Verständnis bezüglich
aufrechterhaltender
Mechanismen
verschiedener
psychischer Störungen beigetragen. Für die Binge Eating
Störung (BES) ist diese Art von Forschung noch am Anfang.
Daher war es Ziel der aktuellen Studie, Aufmerksamkeitsund Gedächtnisverzerrungen für Essensreize bei der BES
zu untersuchen.
Untersuchungsgegenstand und Methode: Eine Gruppe
von Frauen mit BES(n = 30) und eine gewichtsgematchte
weibliche Kontrollgruppe (KG; n = 30) nahm an einer
modifizierten Dot-Probe Task zur Überprüfung einer
Aufmerksamkeitsbias für störungsrelevante Reize teil.
Gedächtnisverzerrungen für Essensreize wurden mit der
Recent Probes Aufgabe untersucht.
Ergebnisse: In der modifizierten Dot-Probe Task zeigten
die BES Probandinnen eine größere Schwierigkeit,
ihre Aufmerksamkeit von Essensreizen im Vergleich zu
neutralen Stimulizu lösen. In der Recent-Probes Aufgabe
waren BES Probandinnen im Vergleich zur KG durch eine
stärkere proaktive Interferenz durch störungsrelevante Reize
charakterisiert, während sich keine Gruppenunterschiede
hinsichtlich der Interferenz durch neutrale Stimuli zeigten.
Zudem ergaben sich signifikante Korrelationen der
essensbezogenen Bias mit dem Störungsschweregrad.
Diskussion: Die Ergebnisse geben Hinweise darauf, dass
die BES durch veränderte Prozesse auf verschiedenen
Stufen der Informationsverarbeitung gekennzeichnet ist.
Im Besonderen binden Essensstimuli die Aufmerksamkeit
bereits in frühen Stufen der Informationsverarbeitung
(Dot-Probe), während essensbezogene Gedächtnisspuren
länger im Gedächtnis persistieren und mit einer
ausgeprägteren kognitiven Interferenz als neutrale Stimuli
einhergehen.
65
21
Does Mindfulness-Based Cognitive Therapy
(MBCT) work without a group? A randomised
controlled trial on acceptability and efficacy of
individual MBCT in diabetes patients
Annika Tovote1; Maya Schroevers1; Joost Keers1; Thera
Links1; Robbert Sanderman1; Joke Fleer1
1
University Medical Center Groningen, The Netherlands
Symposium 21 - Neue Entwicklungen in
der Diagnostik und Behandlung von
Essstörungen
Symposium
S20-05
Symposium
21
S21-02
S21-03
Einfluss der elterlichen Emotionsregulation auf
die nahrungsbezogene Selbstregulationsfähigkeit
bei Kindern mit Essanfallsstörung
Simone Munsch1; Daniela Dremmel1; Laura Bellwald1;
Anja Hilbert1
1
Universität Fribourg, Switzerland
Die ständige Konfrontation mit Nahrungsreizen erfordert
die Fähigkeit des Kindes, körpereigene Hungerreize
von äusserlichen Reizen, die das Verlangen nach
Nahrung auslösen, differenzieren zu können. Die
Regulation der Nahrungszufuhr wird zudem durch
die nahrungsbezogene Belohnungssensitivität, die
Fähigkeit zum Belohnungsaufschub sowie durch
Temperamentsmerkmale und Korrelateder Eltern-KindInteraktion beeinflusst. In der vorliegenden Studie werden
Korrelate der elterlichen Emotionsregulation (emotionale
Intensität und Qualität der Eltern-Kind-Interaktion,
„Expressed Emotions“) bezüglich einer Alltags- sowie
einer nahrungsbezogenen Situation mittels des Five
Minute Speech Samples (FMSS) erfasst. Der Einfluss
auf die Fähigkeit zum Belohnungsaufschub und auf die
generelle und essspezifische Belohnungssensitivität
wird in einer standardisierten Verhaltensbeobachtung
(„Delay of Gratification“, DOG) sowie in einem
computergesteuerten Paradigma (DoorOpening Task) in
einer Gruppe von Kindern mit Essanfallsstörung (Binge
Eating Störung, BES), einer Gruppe mit Kindern mit
einer
Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung
(ADHS) sowie einer Kontrollgruppe mit gesunden
Kindern untersucht. Im Anschluss an die schulbasierte
Rekrutierung nahmen bisher 15 alters-, geschlechts- und
BMI parallelisierte Kinder im Alter von 8 bis 13 Jahren
mit einer BES, 15 Kinder ohne psychische Störung sowie
15 Kinder mit ADHS an der Studie teil. Erste Ergebnisse
zeigen, dass die Eltern-Kind-Interaktion bei BES Kindern
und Kindern mit ADHS in generellen sowohl als auch
in nahrungsbezogenen Situationen im Vergleich zur
Kontrollgruppe gleichermassen durch eine ausgeprägte
Kritik und emotionale Überbeteiligung gekennzeichnet
ist. Diese ist mit vermehrten Selbstregulationsdefiziten
assoziiert: Kinder mit BES und ADHS zeigen im Vergleich
mit gesunden Kontrollen Schwierigkeiten eine unmittelbare
Belohnung zu Gunsten einer späteren, umfassenderen
Belohnung aufzuschieben und perseverieren stärker.
Vor der Therapie – Motivationale Aspekte in der
Prävention und Früherkennung von Essstörungen
Bettina Isenschmid1
1
Inselspital Bern, Switzerland
66
Prävention von Essstörungen ist in primäre, sekundäre
und tertiäre zu unterteilen.
Die primäre Prävention setzt ein, bevor Essstörungen
überhaupt entstehen und fördert die allgemeinen
Lebenskompetenzen. Die sekundäre Prävention richtet
sich auf die möglichst frühzeitige Erkennung und
Behandlung der Krankheit, während die tertiäre Prävention
die Vermeidung von Folgeschäden, die Verbesserung der
Lebensqualität und Verhinderung von Rückfällen zum Ziel
hat. Aktuelle Metaanalysen und eigene Erfahrungen zeigen
klar, dass indizierte, spezifische und in ein Gesamtkonzept
eingebunden Präventionsanstrengungen am meisten
Wirkung zeigen. Ausserdem soll der Fokus nicht einseitig
auf Risikofaktoren, sondern vor allem auf die personalen
und sozialen Ressourcen gerichtet werden und die
Erkenntnisse der motivationalen Gesprächsführung
berücksichtigen. Die Induktion eines schädlichen
Nachahmungseffektes ist dabei zu vermeiden.
Essstörungen generell zu verhindern ist angesichts
eines mehrdimensionalen aetiologischen Konzeptes
kaum möglich. Anstrengungen aber, um die Zahl an
Neuerkrankungen zu vermindern, eine Essstörung
frühzeitig zu erkennen und zu behandeln und rückfällig
gewordene Patientinnen möglichst schnell zu einer
erneuten Therapie zu motivieren, sind äusserst sinnvoll.
Ess-Störungen sind nach wie vor schwerwiegende
Krankheiten. Sie gehören zu den wichtigsten Ursachen
gesundheitlichen Beeinträchtigung von jungen Menschen
und der Anorexia nervosa wird die höchste Mortalitätsrate
aller psychischen Krankheiten zugeschrieben. Lediglich
50 bis 70 Prozent der Patientinnen und Patienten gelingt
es, ihre Krankheit soweit zu bewältigen, dass sie mit ihrem
Leben zurechtkommen. Die Rückfallrate ist allgemein
sehr hoch. Vor diesem eher ungünstigen prognostischen
Hintergrund kommt präventiven Massnahmen eine
besonders grosse Bedeutung zu. Möglichst früh und in
geeigneter Form müssen Risikopersonen angesprochen
werden. Ärzte und Therapeuten sollten alles daran setzen,
betroffene Kinder und Jugendliche – und ihre Eltern–
möglichst frühzeitig zu einer Behandlung zu motivieren
und Rückfälle und Chronifizierung nach Möglichkeit zu
verhindern.
Darauf ist auch das Präventions-, Sensibilisierungs- und
Frühinterventionskonzept der Fachstelle PEP, Bern www.
pepinfo.ch ausgerichtet. Ihre Aktivitäten, die im Rahmen
des Referats beispielhaft dargestellt werden, erstrecken
sich von Beratungen für Risikopersonen, Betroffene,
EABCT 2012
EABCT 2012
Symposium 22 - TCC-Evaluation : du papiercrayon aux nouvelles technologies
Etude préliminaire sur un échantillon de femmes
françaises d’un questionnaire sur l’attachement
prénatal
Anne Denis1; Stacey Callahan2; Martine Bouvard1
1
Université de Savoie, Chambéry, France ; 2Université de
Toulouse II, France
Contexte : L’attachement prénatal renvoie au lien
d’affection qui se développe entre une femme et son
fœtus (Muller, 1993). Trois principaux outils sont
utilisés pour mesurer l’attachement prénatal : la Maternal
Fœtal Attachment Scale (MFAS- Cranley, 1981), la
Maternal Antenatal Attachment Scale (MAAS- Condon
& Corkindale, 1993) et le Prenatal Attachment Inventory
(PAI- Muller, 1993). Parmi ces trois outils, seul le PAI
(Jurgens et al., 2010) a été étudié et validé en français.
Objectif : Cette étude se propose d’étudier les
propriétés psychométriques de la version française
de la MAAS. Ce questionnaire est composé de 19
items, tous consacrés aux sentiments, comportements
et attitudes de la mère envers son fœtus.
Méthode : L’échantillon est composé de femmes en cours
de troisième trimestre de grossesse rencontrées via les
maternités de la région Rhône Alpes. Chacune est invitée
à compléter une fiche anamnestique ainsi que l’adaptation
française de la MAAS et la version française validée de la
PAI. Le recueil est actuellement en cours de déroulement.
Résultats: Les résultats rendront compte des principaux
indices psychométriques de la version française de cet outil
au travers d’analyses factorielles confirmatoires, de l’étude de
la consistance interne et de l’étude de la validité concurrente.
Discussion / conclusion : Les travaux anglophones
suggèrent que la qualité de l’attachement observée
en période anténatale constitue un prédicteur de la
bonne qualité d’attachement observée en période
postnatale (Benoit et al., 1997 ; Condon & Corkindale,
1997) et influence le comportement et le bien être
futur de l’enfant (Huth-Bocks et al., 2004 ; Siddiqui &
Hägglöf, 2000). Les résultats de ce travail permettront
tant aux cliniciens qu’aux chercheurs français
d’avoir accès à un deuxième outil de mesure de ce
concept majeur en psychopathologie périnatale.
67
22
S22-01
Symposium
Angehörige, Lehr- und Fachpersonen, Arbeitgeber
und Behörden, über Informationsveranstaltungen und
Fachseminare an Schulen und Institutionen bis hin
zur Ausbildung von Mediatorinnen und Mediatoren
und Betreuung von Facharbeiten zum Thema. Ebenso
sind Öffentlichkeitsarbeit und die Beteiligung an webPortalen ein wichtiger Teil. Vielfach werden auch ehemals
Betroffene einbezogen, welche authentisch über ihre
Krankheit berichten können und so auch dort die Zuhörer
überzeugen, wo die Erfahrung der Therapeuten letztlich
akademisch bleibt. Generell müssen Fachleute mehr
proaktiv auf Kinder/Jugendliche und ihre Eltern zugehen,
anstatt zu warten, bis sie (zu spät) kommen.
S22-02
Symposium
22
Utilisation de la carte cognitive (mindmap) pour
le pilotage des psychothérapies
Christian Follack1
1
Réseau Fribourgeois de Santé Mentale (RFSM),
Switzerland
La psychothérapie peut être abordée sous l’angle
de la résolution de problèmes complexes,
notamment lorsqu’elle s’insère dans des traitements
pluridisciplinaires de patients présentant des difficultés
psychosociales importantes. Les outils provenant
des sciences de l’information peuvent être utiles aux
psychothérapeutes dans la conceptualisation de cas
des patients complexes. La carte cognitive (« mindmap
») est sans doute un de ces outils prometteurs. Les
logiciels de carte cognitive proposent aujourd’hui un
accès relativement simple à une méthode d’organisation
des informations cliniques qui permet d’obtenir une vue
d’ensemble synthétique des aspects important d’un cas.
Une proposition structure de carte cognitive pour la
conduite de psychothérapie sera proposée et illustrée au
travers d’un exemple de cas de stress post-traumatique
complexe.
S22-03
L’auto-observation informatisée
Tatiana Walther1; Michaël Reicherts1
1
University of Fribourg, Switzerland
De plus en plus de recherches en psychologie clinique
et psychothérapie utilisent des méthodes d’autoobservation informatisées ou d’«évaluation ambulatoire».
Ces méthodes présentent de nombreux avantages en
comparaison à l’utilisation de questionnaires-agenda
papier-crayon tels que la diminution des biais liés au rappel
rétrospectif ou l’évaluation sur le vif dans la situation de la
vie réelle de la personne (Wilhelm & Perrez, 2008).
L’évaluation ambulatoire - à haute résolution - sur
PDA ou Smartphones peut être utilisée dans les
domaines psychophysiologiques, comportementaux,
psychologiques ou de manière combinée. Dans la
recherche sur le vécu affectif, nous avons utilisé le
«Learning Affect Monitor» (LAM ; Reicherts, Salamin,
Maggiori & Pauls, 2007) chez les personnes de 60 à
75 ans (Maggiori 2011), en milieu hospitalier avec des
patients souffrant de troubles somatoformes (Salamin,
2009) ou en relation avec la pratique de l’activité physique
(Walther et al., 2009). Cette dernière recherche montre
par exemple que certaines techniques de traitement telles
qu’utilisées dans la vie quotidienne corrèlent effectivement
avec des mesures du bien-être.
68
Il est indéniable que cette méthode d’évaluation au
quotidien apporte une richesse d’informations sur les
processus et la variabilité du vécu affectif ou de son
interaction avec le comportement, aussi au niveau de
la prise en charge individuelle. Malgré ses avantages,
l’application de l’évaluation ambulatoire informatisée
demande un investissement important au niveau de la
programmation et du traitement des données et est encore
peu appliquée dans la pratique thérapeutique qui se
base surtout sur des mesures rétrospectives et l’hétéroobservation (Wilhelm & Perrez, 2008).
S22-04
Evaluation par juge externe des erreurs
cognitives et du coping dans la dépression : une
étude comparative contrôlée
Joël da Silva1; Ueli Kramer1
1
Université de Lausanne, Switzerland
Introduction : Dans la littérature scientifique, les auteurs
sont d’accord sur le fait que les sujets déprimés présentent
une perturbation dans le traitement des informations. Les
patients dépressifs font des erreurs cognitives et ils ont
recours à des stratégies de coping inadéquates. Identifier
et corriger les erreurs cognitives ainsi que les stratégies
de coping défaillantes, constitue une voie vers la guérison.
Objectifs, méthode et résultats : Cette étude compare
un groupe de patients dépressifs et un groupe contrôle
à l’aide de l’outil de codage CE-CAP qui comporte les
échelles de codage des erreurs cognitives (CE) et des
stratégies de coping (CAP). Le CE mesure 15 erreurs
cognitives, de valence positive ou négative, selon les
définitions de A. T. Beck, et le CAP mesure 12 catégories
de coping, chacune de ces catégories comprend trois
niveaux d’action : affectif, cognitif ou comportemental.
Ces deux échelles se mesurent par juge externe et elles
sont basées sur des transcriptions de séances d’entretiens
cliniques. Un total de 10 patients souffrant de dépression
ont participé à un entretien mesuré, les participants du
groupe contrôle (N=20) ont fait de même. Deux hypothèses
ont été testées dans cette étude : la première précise
qu’un coefficient général de fonctionnement du coping
(OCF) est plus petit chez le groupe de patients dépressifs
par rapport au groupe contrôle ; la deuxième teste si le
groupe de patients dépressifs présente davantage de CE
en comparaison avec le groupe contrôle.
Discussion et conclusion : Ce type d’étude comporte
des intérêts certains pouvant être appliqués à la clinique,
par exemple en identifiant quels types d’erreurs cognitives
sont en rapport avec la dépression et comment ces
dernières se modifient avec la thérapie.
EABCT 2012
L’impulsivité constitue le critère diagnostique le plus
fréquemment mentionné dans le Manuel Diagnostique
et Statistique des Troubles Mentaux (DSM). Plus
spécifiquement, dans le DSM-IV, l’impulsivité est associée
à des troubles tels que les abus de substances, certains
troubles de la personnalité (personnalité «borderline»,
personnalité antisociale), le trouble bipolaire, les déficits
de l’attention/hyperactivité, certaines démences ou encore
les troubles des conduites alimentaires. Les travaux récents
s’accordent sur la nécessité de considérer l’impulsivité
comme un concept multidimensionnel dont les différentes
facettes sont sous-tendues par une variété de mécanismes
exécutifs et motivationnels distincts.
Dans le cadre de cette conférence, je présenterai les
modèles théoriques récents du concept multifactoriel
d’impulsivité. Une attention particulière sera attachée à la
description des mécanismes psychologiques sous-tendant
les facettes de l’impulsivité (par ex. capacité à inhiber des
schémas de réponse dominants, processus délibératifs,
sensibilité accrue pour certains types de renforcements).
Dans un deuxième temps, les outils (questionnaires et
tâches de laboratoire) permettant d’évaluer les facettes de
l’impulsivité et les mécanismes psychologiques associés
seront abordés en détails. Finalement, je soulignerai en
quoi l’approche présentée et les données empiriques qui
l’appuient suggèrent la mise en place, chez les personnes
impulsives, de différents types d’interventions ciblant
de manière spécifique les mécanismes psychologiques
incriminés.
EABCT 2012
S23-01
Improving Prevention of Depression and Anxiety
Disorders: Repetitive Negative Thinking as a
Promising Target
Maurice Topper1; Paul Emmelkamp1; Ed Watkins2;
Thomas Ehring1
1
University of Amsterdam, The Netherlands; 2University of
Exeter, United Kingdom
Introduction : Prevention of depression and anxiety
disorders is widely acknowledged as an important health
care investment. However, existing preventive interventions
have only shown modest effects. To improve the efficacy
of prevention of depression and anxiety disorders, it has
recently been argued that programs should be offered
specifically to individuals scoring high on a given
vulnerability factor and interventions should then directly
target this variable.
Objectives and Methodology : As there is ample
evidence that repetitive negative thinking (worry,
rumination) is causally involved in the onset of depression
and anxiety disorders, the current project aims to prevent
depression and anxiety disorders by targeting repetitive
negative thinking. Adolescents and young adults (aged 1521) showing elevated levels of worry and rumination are
randomized to one of three conditions: group treatment,
internet-based treatment, or a waiting list. Treatment
consist of 6 sessions lasting 1.5 hours each. The training
uses psycho-education, functional analysis, experiential/
imagery exercises and behavioural experiments designed
to decrease avoidance behaviours and to facilitate a shift
from a dysfunctional ruminative style into a more helpful
concrete thinking style.
Results : Uncontrolled pilot data show a significant
reduction in worry and rumination and symptoms of
anxiety and depression. The reported satisfaction with
both types of treatment is high.
Discussion and Conclusions : Recruitment and
data gathering for the randomized controlled trial is
still ongoing. We will present pre-, post-treatment and
follow-up data regarding levels of worry and rumination,
incidence and symptom levels of depression and anxiety
disorders, and possible underlying mechanisms driving
the effects. If the treatment is efficacious and feasible, it
can be seen as a new direction for the dissemination of
effective prevention programs.
69
23
Comment évaluer les différentes facettes de
l’impulsivité?
Joël Billieux1
1
Catholic University of Louvain-La-Neuve, Belgium
Symposium 23 - Worry, rumination
and post-event processing: New
developments in theory, practice and
assessment
Symposium
S22-05
Symposium
23
S23-02
S23-03
Targeting repetitive negative thinking via a
transdiagnostic iCBT treatment for depression
and anxiety
Alishia Williams1; Jill Newby1; Anna McKenzie1; Gavin
Andrews1
1
University of New South Wales, Sydney, Australia
Introduction : Major depressive disorder (MDD) and
generalized anxiety disorder (GAD) are highly co-morbid
disorders characterised by similar cognitive processes
including repetitive negative thinking (RNT) in the form of
worry and rumination.
Objectives and Methodology : To compare a 6-lesson
therapist-assisted internet CBT (iCBT) program for MDD
and GAD to a wait-list group in a CONSORT compliant
randomized control trial (RCT). 108 participants meeting
DSM-IV criteria based on the MINI 5 for MDD or GAD
were enrolled. Exclusion criteria were psychosis, bipolar
disorder, substance abuse or dependence, current use of
benzodiazepines, very severe depression and/or current
suicide intent. The treatment program was delivered via
the Virtual Clinic website www.virtualclinic.org.au, a
not-for-profit research initiative of St Vincent’s Hospital
and the University of New South Wales, Sydney. Each
course consists of 6 online lessons, involving psychoeducation, behavioural activation, cognitive restructuring,
problem solving, graded exposure, relapse prevention,
and assertiveness skills. The lessons also included
information on RNT and strategies and exercises to identify
and challenge beliefs about RNT.
Results : Treatment was more effective compared to
wait-list control on primary measures of depression
and generalized anxiety (PHQ9, BDI-II, GAD; F’s > 19,
p’s < .001) and on secondary measures of distress and
disability (K10, WHODAS; F’s > 9, p’s <.01). Importantly,
the treatment and control groups differed with respect to
rumination and worry (RTQ, PSWQ), as well as beliefs
about the value of rumination (PBRS), F’s > 20, p’s < .001.
Discussion and Conclusions : Results support the
efficacy of iCBT for mixed depression and anxiety and
provide preliminary evidence that RNT can be successfully
targeted over the internet. Follow-up data, limitations and
future directions will be discussed.
The Repetitive Thinking Questionnaire: PostEvent, Looming and Trait Versions in Clinical
and Non-Clinical Populations
Michelle Moulds1
1
University of New South Wales, Sydney, Australia
Introduction : Accumulating evidence suggests
that repetitive negative thinking is a transdiagnostic
phenomenon. However, various forms of repetitive thinking
such as worry, rumination, and post-event processing
have been assessed using separate measures and have
almost exclusively been examined within the generalised
anxiety disorder, depression, and social phobia literatures,
respectively.
Objectives & Methodology: A single transdiagnostic
measure of repetitive thinking is needed to facilitate
the assessment of repetitive thinking across disorders.
Accordingly, we developed the Repetitive Thinking
Questionnaire (RTQ) by removing diagnosis-specific
content from existing measures of worry, rumination, and
post-event processing.
Results: In an undergraduate sample, the repetitive
negative thinking subscale of the RTQ was significantly and
uniquely associated with a range of emotions, suggesting
that it may be a useful trans-emotional measure. Data from
the original version of the RTQ will also be presented from
a study with a treatment-seeking sample at a specialist
anxiety disorders unit. Data will also be presented on two
new versions: a looming version and a shortened trait
version.
Discussion and Conclusions: While the various forms
of repetitive thinking loaded on a single factor in a nonclinical sample, different forms of repetitive thinking were
distinguishable in clinical samples, namely Negative
Brooding and Repetitive Thinking. The Negative Brooding
factor includes items that assess dwelling on the past,
whereas the Repetitive Thinking factor reflects engagement
in the process of repetitive thinking independent of content.
The relationships between these forms of repetitive
thinking and symptoms of various anxiety and affective
disorders, as well as constructs thought to maintain
repetitive thinking, will be reported.
70
EABCT 2012
The Contribution of Attentional Bias to
Worry: Distinguishing the Roles of Selective
Engagement and Disengagement
Colette Hirsch1; Colin MacLeod2; Andrew Mathews3;
Oneet Sandher1; Amruti Siynai1; Sarra Hayes1
1
King’s College London, United Kingdom; 2University of
Western Australia; 3University of California, Davis, USA
Introduction : This study investigated the effect on worry
of biased attentional engagement and disengagement.
Objectives & Methodology : Variants of a novel
attention modification paradigm were developed, designed
to induce a group difference either in participants’ tendency
to selectively engage with, or disengage from, threatening
meanings.
Results : An index of threat bias, reflecting relative
speeding to process threat word compared to non-threat
word content, confirmed that both procedures were effective
in inducing differential attentional bias. Importantly, when
the induced group difference in attentional bias followed
the procedure designed to influence selective engagement
with threat meanings, it also gave rise to a corresponding
group difference in worry. This was not the case when
it was induced by the procedure designed to influence
selective disengagement from threat meanings.
Discussion and Conclusions: These findings suggest
that facilitated attentional engagement with threat meanings
may causally contribute to variability in worry.
The contents and causes of post-event
processing
Steve Makkar1
1
University of New South Wales, Sydney, Australia
EABCT 2012
Introduction : Post-event processing (PEP), the act of
engaging in detailed, self-focused, and negatively-biased
repetitive thinking regarding a prior social event, has been
hypothesised to contribute to the maintenance of social
phobia. Unfortunately, scarce research has investigated the
precise cognitive contents of PEP, as well as the variables
that predict PEP.
Objectives and Methodology: This study aimed to
examine cognitive factors that trigger PEP. Participants
were exposed to a false heart rate simulation displaying
either an increase or decrease in heart rate. They then
rated their affect, cognition, and behaviour during the
speech. Twenty-four hours later, we assessed participants’
frequency of engaging in PEP, as well as the cognitive and
image-based contents of this process.
Results: Participants who saw their rates increasing
(versus decreasing) experienced more anxiety, negative
thoughts, and reported a greater frequency of PEP.
Furthermore, these participants reported having more
frequent negative self-focused thoughts during PEP, and
fewer positive thoughts. Effects were mediated by an
increase in self-focused attention. In addition, high socially
anxious subjects in general experienced high-standard
thoughts, negative self-evaluations, and catastrophic
thoughts during PEP compared to low socially anxious
subjects.
Discussion and Conclusion: The results emphasise
that PEP is dominated by negative self-focused thoughts,
and that self-focused attention on physiological cues
perpetuates negative self-thinking after social situations.
Consequently, treatment of social phobia should include
novel techniques such as attentional training and/or
attention bias modification to deal with problematic selffocused attention and reduce PEP.
71
23
S23-05
Symposium
S23-04
Symposium 24 - Cognition in OCD – Old
constructs and new questions
S24-01
Symposium
24
Cognitive change during CBT in children and
adolescents with OCD
Raquel Nogueira Arjona1; Antonio Godoy Avila1; Aurora
Gavino Lazaro1; Pablo Romero Sanchiz1
1
University of Malaga; Spain
Introduction: Cognitive behaviour therapy (CBT) for
Obsessive-compulsive disorder (OCD) among children
and adolescents has traditionally been more focused on
behaviour than on cognitions. This is probably because
of the assumption that, compared to adults, cognitive
schemas are less developed in children and adolescents.
However, there is evidence that cognitive constructs
identified among adults such as excessive responsibility,
perfectionism or importance given to the thoughts are
also present among young patients, even in non-clinical
samples of children and adolescents.
Objectives and Methodology: This presentation reports
on the change in cognitive constructs during CBT with 10
children and adolescents with OCD and other comorbid
disorders, using single-case and pre-post methodologies.
The cognitive constructs were measured with the Obsessive
Beliefs Questionnaire – Children Version, the Thought
Action Fusion Scale and the Responsibility Attitudes
Scale. Results. The results show that, as expected,
significant change on these measures accompanied the
reduction of obsessive compulsive behaviours during
therapy, especially after exposure and response prevention
plus cognitive therapy phase, compared to baseline and
psychoeducation. This reduction remained after one
month and three months of follow up.
Discussion and Conclusion: The influence of variables
like age, gender and comorbidity in these OCD related
variables and their change during therapy are discussed.
The implications for the treatment of OCD in children and
adolescents, and the assessment and change of OCD
related beliefs in these populations are also discussed.
72
S24-02
Responsibility, uncertainty and OCD symptoms
revisited: Semi-idiographic assessment VS.
belief scales
Mark H. Freeston1; Karen Price1, Kate Lomax1
1
Newcastle University, United Kingdom
In 1997 the OCCWG, an international group of clinicianresearchers working on the development of measures
of beliefs and appraisals associated with OCD, laid out
proposals for the assessment of cognitions related to OCD.
They identified some cognitive domains and, in addition
to belief measures, argued that idiographic strategies
could be used and may offer certain advantages. However,
despite large volumes of research generated with the belief
measures over the last 15 years, there has been relatively
little with other forms. This presentation looks at whether
semi-idiographic measures can be used to assess such
constructs as responsibility and intolerance of uncertainty
and whether they account for additional variance in OCD
symptoms over and above belief measures. For this study,
five typical OCD scenarios were selected that commonly
occur in non-clinical samples. These brief scenarios
covered checking, magical thinking, impulsivity, ordering
and contamination. 199 healthy volunteers rated each for
personal salience and then rated the most personallysalient on a number of dimensions including how
frequency, likelihood and severity, and central to this study,
responsibility and uncertainty. They also completed other
measures including Obsessive-Compulsive Inventory,
the Obsessive Beliefs Questionnaire (Responsibility and
Uncertainty Subscales). Results show that the beliefs
and situational appraisals were only weakly correlated.
However, each accounted for unique and approximately
equal variance in obsessive-compulsive symptoms.
Even when subject to stringent tests controlling for
scenario chosen and ratings of the situation, they still
made independent contributions. These findings suggest
that both assessment approaches are capturing separate
variance in symptoms. The implications are briefly
discussed including on-going research with clinical
samples and the development of intervention strategies for
these constructs.
EABCT 2012
Categorical and dimensional approaches to
understanding intrusive thoughts in OCD, GAD
and Health Anxiety
Pablo Romero Sanchiz1; Raquel Nogueira Arjona1;
Antonio Godoy Avila1; Aurora Gavino Lazaro1;
1
University of Malaga, Spain
Introduction : The investigation of intrusive thoughts
has been one of the most fertile areas of study in clinical
psychology in recent years. This is because there are a
range of presentations and several disorders (e.g. OCD,
GAD and Health Anxiety i.e.) in which the presence of
intrusive thoughts is fundamental to diagnosis, central to
various cognitive models, and targeted in treatment.
Objectives and Methodology: The present investigation
examined intrusive thoughts and their appraisals,
emotions and strategies using a dimensional perspective.
Three groups of patients with OCD (N = 35), GAD (N =
35) and Health anxiety (N = 32) respectively completed
a battery of questionnaires that included OCI-R, S-HAI,
WAQ, and an extended version of the Cognitive Intrusions
Questionnaire, adapted specifically to examine a wider
range of disorders than earlier studies. Results. The results
show certain specific patterns consistent with predictions
of cognitive models, such as responsibility, disgust,
egodistonicity and neutralization strategies, i.e. are higher
in OCD sample, IoU, worry and anxiety are higher in GAD
sample and “body sensation triggered” is higher in Health
anxiety sample.
Discussion and Conclusion: Results are discussed
from a dimensional perspective that goes further than the
traditional categorical point of view. It is argued how this
perspective could be useful for better understanding of the
different disorders and in both diagnostic and therapeutic
areas.
Investigating the relationship between motor
inhibition ability and Not Just Right Experience
in patients with Obsessive Compulsive Disorder
Gioia Bottesi1; Marta Ghisi1; Claudio Sica1; Enzo Sanavio1
1
University of Padova; Italy
EABCT 2012
Introduction: Obsessive Compulsive Disorder (OCD)
is characterized by difficulties in suppressing repetitive
thoughts and actions. Thus it could be conceptualized as
a “pathology of stopping”: patients generally report their
inability to stop compulsive rituals as more disturbing
and impairing than the feeling of being driven to perform
them. Moreover, experimental evidence supports the
presence of deficits in motor inhibition in OCD. Not Just
Right Experiences (NJRE) have also been proposed as
involved in termination of compulsions in OCD. People
experiencing these uncomfortable feelings of “things
being not just right” generally report being compelled
to continue to execute an action in order to reduce the
discomfort associated with them until they perceive things
as “just right”.
Objectives and Methodology: The main aim was
to explore the relationship between NJRE and motor
inhibition ability in OCD. Twenty-two OCD patients and 22
healthy controls (HC) entered the study. They completed
several self-report measures and a computerized Go/
Nogo task assessing motor inhibition ability. Results:
Among the OCD group, an association between higher
NJRE severity and slower reaction times (RTs) was found,
whereas no correlation between OCD severity and Go/
Nogo performance emerged. Anxiety and depression
levels did not account for the behavioural performance on
the task. Moreover, OCD patients made more commission
errors than HC.
Discussion and conclusion: Our results support the
idea that trying to achieve “just right” feelings as a criterion
among OCD patients leads to longer times to make a
decision. The contrast between the correlational data (not
related to OCD severity) and the group data (OCD patients
who are also anxious and depressed) would suggest that
the performance of OCD patients may not be specifically
and uniquely due to the OCD symptoms. On the other
hand, our findings suggest that only NJRE accounts for
slowness among patients, rather than OCD severity.
73
24
S24-04
Symposium
S24-03
Symposium 25 - CBT groups in different
settings
S25-01
Symposium
25
Group CBT for anxiety disorders
Jan Prasko1; Dana Kamaradova1; Jana Vyskocilova1;
Ales Grambal1; Daniela Jelenova1; Zuzana Sigmundova1;
Kristyna Vrbova1
1
University Palacky Olomouc, University Hospital
Olomouc, Czech Republic
Anxiety disorders are chronic psychiatric conditions with
a low rate of natural remission, producing substantial
decreases in the quality of life and numerous specific
social role impairment and disabilities. Over past 20 years,
behavioral, cognitive, and cognitive behavioral procedures
(primarily exposure and cognitive reconstruction based
treatments) were found to be effective in the treatment of
anxiety disorders. The purpose of this symposium is to
present the main principals and techniques of a shortterm group cognitive behavioral therapy for anxiety
disorder, show programs of different groups of anxiety
disorders (panic disorder, OCD, social phobia and mixed
group with pharmacoresistant inpatients) used in our
praxis. We describe basic strategies including using the
group dynamics and working with difficult patients in
group. The video presentation is included. The results of
our research studies will be discussed. In our work, we
combine education, cognitive reconstruction, behavioural
experiments, exposure therapy, social skills training and
problem solving approach. Supported by grant IGA MZ CR
NT 11047-4/2010.
S25-02
Group CBT program for patients with panic
disorders and agoraphobia
Dana Kamaradova1; Tomas Diveky1
1
University Palacky Olomouc, University Hospital
Olomouc, Czech Republic
We describe step by step the cognitive-behavioral group
therapy of patients with panic disorder and/or agoraphobia.
We are explaning the concept of cognitive model of
panic disorder also the concept of group CBT in these
patients. Shortly we focus of therapeutic steps starting
with individual preparation to the group, psychoeducation,
working with vicious circle of panic attack, explanation of
consequences of avoidant and safety behaviors, cognitive
reconstruction, control of breathing, interoceptive
exposure and step by step exposure in vivo. Lectures about
working with cognitive schemas are included. The results
74
of our research in this group concerning the efficacy of the
program (assessed by psychiatric rating scales and QoL),
changes in the heart rate variability during program and
EEG changes (using sLORETA) are presented. We also try
to point on possible complications that may occur during
the therapy and coping with them. Supported by grant IGA
MZ CR NT 11047-4/2010.
S25-03
Group CBT for patients with obsessive
compulsive disorder
Zuzana Sigmundova1; Jan Prasko1; Jana Vyskocilova1;
Ales Grambal1; Dana Kamaradova1; Michal Raszka1
1
University Palacky Olomouc, University Hospital
Olomouc, Czech Republic
Newer treatments, specifically cognitive behavioral
therapy and serotonergic agents, have helped significantly
in symptom ameliorati¬on in OCD patients. The treatment
steps in individual CBT are repeatedly described last 40
years, less known are approaches in group CBT of OCD.
The purpose of this lecture is to demonstrate the main
principals and techniques of a short-term group cognitive
behavioural therapy for OCD patients. We also present the
data from our study . The purpose of the present study is
to examine the effectiveness of group CBT on a sample
of non-selected, pharmacoresistant OCD patients and
to find the predictors of successful treatment in these
conditions. The therapy was conducted in a naturalistic
setting and systematic CBT steps were adapted to
each patient. Pharmacological treatment underwent no
or minimal changes during the trial period. Outcome
measures included the Yale-Brown Obsessive Compulsive
Scale, subjective version (S-Y-BOCS), the Clinical
Global Impressions-Severity of Illness scale (CGI-S),
Beck Depression Inventory (BDI), Beck Anxiety Inventory
(BAI), Somatoform Dissociation Questionnaire (SDQ-20)
and Dissociative Experience Scale (DES). The primary
outcome measure for treatment response was a rating of
35% improvement in Y-BOCS. A remission was defined
by S-Y-BOCS score 12 and lower or by CGI-S scores 1 or
2. 47 patients completed the trial (19 male and 28 female).
One patient refused the protocol. All patients finished
minimum of 5 weeks of intensive group CBT (every day
program for 6 hours) and showed statistically significant
improvement on S-Y-BOCS, CGI-S and BDI scales. At the
end of the therapy 40,4 % of patients reached remission
according CGI-S. The main predictors of achieving the
response or remission were scores in S-Y-BOCS lower
than 22, good insight, high resistance against symptoms,
low level of dissociation, and aggressive character of
obsessions.
EABCT 2012
IDEM, a flexible CBT-inspired group designed for
depressed inpatients and outpatients
Luisa Weiner1; Gilles Bertschy1
1
Strasbourg University Hospital, France
Background: IDEM (Information, Discovery, Exchange &
Mobilisation regarding depression) is a psychoeducation and
CBT-inspired intensive group psychotherapy we have designed
to suit the needs of depressed inpatients and outpatients alike.
Since it caters to patients at different stages of their illness, with
variable hospital stay durations, IDEM was conceived as a very
flexible open group cycle, with fixed themes developed during
each session. Each session aims at providing information
regarding different aspects of mood disorders, instilling hope,
self-efficacy and awareness of psychotherapeutic tools (i.e.,
behavioral activation, cognitive therapy, emotion regulation,
mindfulness) through interpersonal relationships and insession behavioral experiments (Discovery, Exchange and
Mobilisation, in IDEM) .
Aims: To describe the feasibility of such a group and to
evaluate patients’ satisfaction and mood changes during
sessions.
Method: Feasibility will be reported in a narrative way.
Since IDEM is an adjuvant psychotherapy group in
addition to pharmacotherapy, individual supportive and
institutional therapies, mood changes between group
entry and exit would not be informative about the specific
contribution of IDEM group participation: thus, only mood
changes observed during each session were assessed
via a visual analog scale ranging from 0 (low mood) up
to 100 (euphoric mood) before and after each session.
Patients’ global satisfaction was evaluated via the Client
Satisfaction Questionnaire (CSQ-8) and an ad hoc selfreport questionnaire, the IDEM satisfaction questionnaire
(4 open-ended questions, and 4 quantitative questions).
Results: 52 patients (18 male; age range : 22-73 years)
participated from January 2011 until April 2012. The
vast majority of patients had bipolar disorder. BDI-II and
Rosenberg self-esteem scale mean scores upon admission
were 26,85 and 23,68, respectively. 2h sessions took place
twice a week; each cycle lasted circa 2 months.
Mean mood results increased at the end of sessions. CSQ8 and IDEM satisfaction questionnaire results suggest a
high global satisfaction rate.
Discussion: Preliminary data suggest that IDEM
psychotherapy group is a feasible concept. Indeed, patients’
satisfaction and mood improvement during sessions
seem to indicate that it might be an efficient adjuvant to
pharmacotherapy. Moreover, acceptability among other
health professionals is high – many of them participate in
different sessions of each cycle, which contributes to the
coherence of patients’ care.
Long Term Follow up of Cognitive Behavior
Group Therapy (CBGT) in
Drug-naive and Drug-resistant Social Anxiety
Disorder (SAD) patients
Sofi Marom1; Eva Gilboa-Schechtman2, Idan M. Aderka3,
Jonathan Kushnir4; Tal Tavor1, Cfir Seifert1, Hermesh
Haggai5
1
Ruppin Academic Center, Emek Hefer; 2Bar Ilan
University, Israel; 3Boston University, USA; 4University of
Houston, USA; 5Tel-Aviv University, Israel
EABCT 2012
Background: Long term research on follow up of
completers of CBGT for SAD is scarce. Five hundred and
twenty patients (50% women) completed 18-session CBGT
between 1995-2011. Twenty two percent were medicated
by SSRIs during CBGT. Severity of SAD, depression and
level of functioning was assessed at the beginning and
end of treatment. The purpose of the present study is
twofold: 1. To examine the long term (1-15 years) outcome
of SAD following the completion of CBGT. 2. To compare
current SAD status of resistant to medication versus nonmedicated patients.
Method: Patients that completed treatment will be
approached firstly by telephone. The aim of the study will
be explained to them. If they agree to participate in the
study, a link will be sent to them electronically containing
an informative questionnaire and the three questionnaires
given at start and end of CBGT (Liebowitz Social Anxiety
Scale, Sheean Disability Scale and the Beck Depression
Inventory). The informative questionnaire will inquire
about their current familial, education and work status, and
in addition information regarding use of psychological and
pharmacological treatments since termination of CBGT.
Patients will send the completed questionnaires through
the Internet.
Results: We will use Regression Analyses to determine
the variables which predict long term poor and beneficial
SAD and depression status. In addition, we will compare
the efficacy of CBGT of SAD for resistant to medication
versus non-medicated SAD patients.
75
25
S25-05
Symposium
S25-04
Symposium 26 - Cognitive Processes
in Eating Disorders: Etiology and
Treatment Implications
S26-01
Symposium
26
Specificity of Eating-Related Cognitive
Distortions
Jennifer Coelho1; Céline Baeyens2; Christine Purdon3;
Audrey Pitet4; Martine Bouvard4
1
McGill University, Montreal, Canada; 2Université
Pierre-Mendès France, Grenoble, France; 3University
of Waterloo, Canada; 4Université de Savoie, Chambéry,
France
Introduction: Thought-Shape Fusion (TSF) is a cognitive
distortion linked with eating pathology; however, the
specificity of this distortion to eating disorders has not yet
been examined. TSF represents an extension of a similar
phenomenon that is relevant to obsessional pathology,
thought-action fusion (TAF). Individuals with eating
disorders report high levels of TAF, suggesting that there
may be shared cognitions across these two disorders.
Objectives and Methodology: The current study set
out to investigate whether individuals with obsessivecompulsive disorder (OCD) are susceptible to TSF, just as
individuals with eating disorders are susceptible to TAF.
The effects of a TSF induction was investigated in three
groups of women: individuals with an eating disorder (n
= 33), individuals with obsessive-compulsive disorder
(OCD; n = 24), and control women with no history of either
an eating disorder or obsessive-compulsive disorder (n
= 26). Participants’ received either a TSF induction or a
neutral induction, and their subsequent cognitive and
behavioral responses were assessed.
Results: The results demonstrated the specificity of
TSF, as individuals with eating disorders (but not OCD)
reported higher state TSF, more negative affect, and more
neutralization behavior after the TSF induction relative to
the neutral induction. Control participants demonstrated
higher trait TSF, and increased self-reported distress/
difficulty in imagining a food-related situation than did
women with OCD.
Discussion and Conclusion: The fact that control
participants were more susceptible to TSF than were women
with OCD suggests that the development of TSF does not
necessarily rely on the presence of psychopathology. The
role of eating-related cognitions in eating pathology, and
the possibility of shared cognitions in the etiology of
eating disorders and OCD will be discussed.
76
S26-02
Media exposure and negativ e body image: The
role of cognitive factors
Simone Munsch1; Andrea Wyssen1; Jennifer Coelho2;
Grégoire Zimmermann3; Ramona Burgmer4, Stephan
Herpertz4
1
Universität Fribourg, Switzerland; 2McGill University,
Montreal, Canada; 3Université de Lausanne, Switzerland;
4
LWL-Universitätsklinikum der Ruhr-Universität Bochum,
Germany
Introduction: Engagement in mass media is associated
with negative body image and disordered eating behavior
in the general population. Cognitive distortions might
moderate the impact of mass media.
Objectives: We investigate the influence of laboratory
media exposure on mood, body image and stress
response in young male and female individuals. We
evaluate whether the impact of media exposure is
increased by cognitive distortions such as „thoughtshape fusion“ (TSF). According to this concept the mere
thought of food induces shame, guilt and fear of weight
gain. Correspondingly, imagining thin beauty ideal might
trigger irrational thoughts.
Methodology: The study design is an adapted version
of the waiting-room paradigm of Turner et al. (1997). The
experimental group is exposed to magazines representing
the thinness ideal, the control group is asked to look at
magazines with neutral topics. TSF is induced according
to Shafran et al. (1999). The effect of media exposure and
TSF induction is assessed by questionnaires and by saliva
cortisol.
Results: Preliminary results indicate a decrease in body
image satisfaction after exposure as well as an increase
in negative mood and stress response. No differences
between men and women emerged. TSF induction
amplified the effect of media exposure.
Discussion: Laboratory exposure to mass media increases
negative mood, body image and stress response. We will
further investigate whether TSF moderates the impact of
mass media engagement and whether mechanisms are
different in groups with ED compared to groups with
mixed mental disorders.
Conclusion: Exposure to the thinness ideal via mass
media in laboratory affects healthy young males and
females. It can be suggested that daily exposure puts
certain individuals at risk for the development of negative
mood, body image and disordered eating behavior.
Cognitive processes amplify these mechanisms.
EABCT 2012
The effectiveness of Cognitive Remediation
Therapy on psychopathology in patients with
severe eating disorders: A randomized controlled
trial
Alexandra Dingemans1; Unna Danner2; Judith Donker1;
Jiska Aardoom1; Charlotte van der Kruijk2; Sandra Bom1;
Mirjam van der Geest1; Karine Tobias2; Annemarie van
Elburg2; Erich van Furth1
1
Center for Eating Disorders Ursula, Leidschendam, The
Netherlands;
2
Altrecht Eating Disorders Rintveld, Zeist, The
Netherlands
Introduction: Individuals with eating disorders (ED) have
very rigid and inflexible cognitions and thinking styles,
which may perpetuate the extreme focus on weight/shape
and rigid eating behaviors. This rigidity also effects daily
functioning, self-esteem and motivation for treatment.
Cognitive Remediation Therapy (CRT) is an intervention
that improves the awareness of ongoing thinking
processes (Tchanturia et al., 2008). CRT is not about what
patients think, but how they think. The aim of this study is
to examine the effectiveness of CRT in addition to intensive
clinical treatment for ED (Treatment-As-Usual, TAU).
Method: Eighty-two patients (ANr n=46; ANbp n=27;
BNp n=9) were randomly assigned to CRT plus TAU
(N=41) or TAU alone (N=41). Ten individual sessions
of CRT are given within 5 weeks. Neuropsychological
tests and questionnaires measuring eating disorder
psychopathology, depressive and anxiety symptoms,
motivation, quality of life (QOL) and self-esteem were
administered at baseline (T0, N=82), 6 weeks (T1, N=75)
and 6-months follow-up (T2, N=67). Data were analyzed
by means of linear mixed model analyses.
Results: The results revealed significant time (T0-T1) x
condition effects for ED-specific QOL and a time (T0-T2) x
condition effect for eating disorder psychopathology. TAU
plus CRT was found to be more superior in decreasing
eating disorder psychopathology and increasing EDspecific QOL compared TAU alone. Time effects were
found for most outcome variables especially at follow-up
(T0T2), i.e. an increase in BMI and quality of life (SF36)
and a decrease in perfectionism and in depressive and
anxiety symptoms.
Conclusion: There was continuing improvement of
psychological functioning after the end of CRT. CRT seems
to increase the effectiveness of simultaneous intensive
treatment for individuals with a severe eating disorder.
Neural Mechanism Underlying Theory of Mind
and the Relation to Treatment Outcome in
Juvenile Anorexia Nervosa
Kerstin Konrad1,2,4; Martin Schulte-Rüther1,2; Verena
Vorhold1,2; Gereon R. Fink2,3; Beate Herpertz-Dahlmann1,2,4
1
University Hospital Aachen, Germany; 2Institute of
Neuroscience and Medicine (INM 3), Research Center
Jülich, Germany; 3University Hospital Cologne, Germany;
4
JARA-Brain Translational Medicine
EABCT 2012
Objective: Converging evidence suggests that key aspects of
social functioning, such as theory of mind (ToM) processing,
are impaired in patients with anorexia nervosa and that
these impairments are related to long-term outcome. Thus,
the current study aimed to investigate neural mechanism of
ToM in females with anorexia nervosa before and after weight
rehabilitation.
Methods: Nineteen adolescent patients and 21 age- and
IQ-matched controls, (aged 12-18y) were investigated
with a ToM-task using functional magnetic resonance
imaging. Patients were investigated upon admission (T1)
and at discharge from hospital after weight recovery (T2).
A follow-up investigation determined clinical outcome one
year after admission.
Results: Irrespective of time point, patients showed
reduced activation in middle and anterior temporal cortex
and in the medial prefrontal cortex during ToM reasoning.
This hypoactivation could not be explained by starvationinduced changes in grey matter volumes. The degree of
hypoactivation in the medial prefrontal cortex at T1 was
correlated with clinical outcome at follow-up.
Conclusions: Hypoactivation in the brain network
supporting ToM may be associated with a social-cognitive
endophenotype reflecting impairments of social functioning
in anorexia nervosa. Hypoactivation in temporal brain
areas may underlie deficiencies in the extraction of socioemotional information from social scenes and insufficient
integration into a social context. Hypoactivation in mPFC
further suggests aberrancies in the metacognitive abilities
to mentalize about other people which may be predictive
for a poor outcome at one year follow-up. Implications
for psychotherapeutic interventions in juvenile AN will be
discussed.
77
26
S26-04
Symposium
S26-03
S26-05
Symposium
27
Binge eating disorder in adolescents: A
randomized psychotherapy trial
Anja Hilbert1; Rebekka Müller1; Ricarda Schmidt1; Anne
Tetzlaff
1
University of Leipzig Medical Center, Germany
Introduction: Recent research indicates that binge eating
disorder (BED) is a prevalent health condition in adolescents.
BED is associated with an increased eating disorder and
general psychopathology, impaired quality of life, and
overweight and obesity. Despite BED´s clinical significance,
age-adapted approaches to treatment are lacking. Objectives:
The goal of this research project is to evaluate in adolescents
with BED the efficacy of an age-adapted cognitive-behavioral
therapy program, the gold standard treatment for adults with
BED.
Methodology: In a single-center randomized-controlled
efficacy trial, 60 adolescents meeting the DSM-IV-TR or
DSM-5 criteria of BED will be randomized to CBT or a
waiting-list (WL) control condition. Using an observer-blind
design, patients are prospectively assessed at baseline, midtreatment, post-treatment, six-months, and twelve-months
follow-up after end of treatment. The cognitive-behavioral
treatment program for adolescents focuses on eating behavior,
body image, and stress and emotions. The primary endpoint
is the number of binge eating days over the last 28 days at
posttreatment assessed by a state-of-the art clinical interview.
Secondary outcome measures include the specific eating
disorder psychopathology, general psychopathology, mental
comorbidity, anthropometrics, self-esteem, and quality of life.
Results: Baseline sample descriptives will be presented.
Conclusion: Results from this ongoing clinical trial will
contribute to the implementation of effective evidence-based
treatment options of adolescent BED. As youth with binge
eating is at risk of further weight gain, cognitive-behavioral
treatment may also help to prevent obesity.
78
Symposium 27 - Hormones and Anxiety
disorders
S27-01
Endogenous cortisol levels influence extinctionbased psychotherapy in spider phobics
Johanna Laas-Hennemann1 ; Tanja Michael1
1
Saarland University, Saarbrücken, Germany
Background: Intrusive memories are the hallmark
symptom of PTSD. Accumulating evidence suggests
that PTSD is associated with low cortisol levels. Acute
elevations of cortisol are known to impair the retrieval
of already stored memory information. Thus, continuous
cortisol administration might help in reducing intrusive
memories in PTSD. Strong perceptual priming for
neutral stimuli associated with a traumatic context has
been shown to be one important learning mechanism
that leads to traumatic memories. However, the memory
modulating effects of cortisol have only been shown for
explicit declarative memory processes. Thus, in our
study we aimed to investigate whether cortisol influences
the retrieval of perceptual priming of neutral stimuli that
appeared in a traumatic context.
Methods: Two groups of healthy volunteers (N = 160)
watched either neutral or “traumatic” picture stories on
a computer screen. Neutral objects were presented in
between the pictures in each group. Memory for these
neutral objects was tested on the next day with a perceptual
priming task and an explicit memory task. Prior to recall
half of the participants in each group received 25 mg of
cortisol, the other half received placebo.
Results: Participants in the traumatic stories/placebo
condition showed more perceptual priming for the neutral
objects than participants in the neutral stories/placebo
condition indicating a strong perceptual priming effect
for neutral stimuli presented in a “traumatic context”.
In the cortisol-condition this effect was not presented:
Participants in the neutral stories/cortisol and participants
in the traumatic stories/cortisol condition showed about
the same amount of priming for the neutral objects.
Conclusion: Our findings show that cortisol inhibits the
retrieval of perceptual priming of neutral stimuli that appeared
in a traumatic context. These findings indicate that cortisol
also influences PTSD-relevant memory processes and
thus further support the idea that administration of cortisol
might be an effective treatment strategy in reducing intrusive
reexperiencing.
EABCT 2012
Effects of acute cortisol administration on
perceptual priming of trauma-related material
Tanja Michael1; Johanna Laas-Hennemann1; Elena Holz1
1
Saarland University, Saarbrücken, Germany
Background: Intrusive memories are the hallmark
symptom of PTSD. Accumulating evidence suggests
that PTSD is associated with low cortisol levels. Acute
elevations of cortisol are known to impair the retrieval
of already stored memory information. Thus, continuous
cortisol administration might help in reducing intrusive
memories in PTSD. Strong perceptual priming for
neutral stimuli associated with a traumatic context has
been shown to be one important learning mechanism
that leads to traumatic memories. However, the memory
modulating effects of cortisol have only been shown for
explicit declarative memory processes. Thus, in our
study we aimed to investigate whether cortisol influences
the retrieval of perceptual priming of neutral stimuli that
appeared in a traumatic context.
Methods: Two groups of healthy volunteers (N = 160)
watched either neutral or “traumatic” picture stories on
a computer screen. Neutral objects were presented in
between the pictures in each group. Memory for these
neutral objects was tested on the next day with a perceptual
priming task and an explicit memory task. Prior to recall
half of the participants in each group received 25 mg of
cortisol, the other half received placebo.
Results: Participants in the traumatic stories/placebo
condition showed more perceptual priming for the neutral
objects than participants in the neutral stories/placebo
condition indicating a strong perceptual priming effect
for neutral stimuli presented in a “traumatic context”.
In the cortisol-condition this effect was not presented:
Participants in the neutral stories/cortisol and participants
in the traumatic stories/cortisol condition showed about
the same amount of priming for the neutral objects.
Conclusion: Our findings show that cortisol inhibits
the retrieval of perceptual priming of neutral stimuli
that appeared in a traumatic context. These findings
indicate that cortisol also influences PTSD-relevant
memory processes and thus further support the idea that
administration of cortisol might be an effective treatment
strategy in reducing intrusive reexperiencing.
Stress Buffering Effects of Oxytocin and Social
Support in Social Phobia
Bernadette von Dawans1; Leila M. Soravia2; Inga D.
Neumann3; C. Sue Carter4; Dominique de Quervain5;
Ulrike Ehlert5; Markus Heinrichs1
1
University of Freiburg, Germany; 2University Hospital of
Psychiatry Berne, Switzerland; 3University of Regensburg,
Germany; 4University of Illinois at Chicago, USA;
5
University of Zurich, Switzerland
Introduction: Social phobia ranks as the third most
common mental health disorder. Besides marked and
persistent fear of social interactions, patients report
avoidance and various physical symptoms including
sweating or tachycardia, which in turn reinforce phobic
fear. Current treatments of the disorder, which include
psychotherapeutic as well as pharmacological approaches,
are effective on some patients but are also associated with
a high rate of non-response. In healthy subjects, social
support and oxytocin have already been shown to reduce
stress responses and improve social cognitions.
Methods: In a placebo-controlled, double-blind study, 65
patients with social phobia and 79 healthy controls were
exposed to a socio-evaluative stressor (Trier Social Stress
Test), consisting of 5 minutes of an unprepared speech
followed by a 5-minute mental arithmetic task in front
of an audience. All participants were randomly assigned
to receive intranasal oxytocin (24 I.U.) or placebo 50
minutes before stress, and either social support from their
spouse during the preparation period or no social support.
Participants‘ physiological responses (cortisol and heart
rate) and psychological responses (subjective stress) were
repeatedly assessed throughout the session.
Results/Discussion: The social phobia group showed
higher baseline measures in all physiological and
psychometric measures, which could be interpreted as an
exaggerated anticipatory response. There was a three-way
interaction, indicating stress-buffering effects for oxytocin
as well as social support in the patient group in heart rate
responses to stress. The combination of oxytocin and
social support reduced avoidance in social phobia and
oxytocin alone reduced subjective physical symptoms
in the patient group. Future studies should test whether
oxytocin treatment can improve cognitive-behavioral
therapy for social phobia.
EABCT 2012
79
27
S27-03
Symposium
S27-02
S27-04
Influence of stress on fear extinction in an
aversive differential conditioning paradigm in
humans
Dorothée Bentz1, Tanja Michael2, Frank H. Wilhelm3,
Francina R. Hartmann1, Sabrina Kunz1, Isabelle R. Rudolf
von Rohr1, Dominique J.-F. de Quervain1
1
University of Basel, Switzerland; 2Saarland University,
Saarbrücken, Germany; 3University of Salzburg, Austria
Symposium
28
Introduction: Behavioral exposure therapy of anxiety
disorders is believed to rely on fear extinction. Animal,
preclinical and clinical studies indicate that glucocorticoids
– stress hormones released from the adrenal cortex promote fear extinction processes. There is abundant
evidence that stress and stress hormones reduce
memory retrieval of emotional information, whereas they
enhance memory consolidation of new information. We
hypothesized that this two-fold action of stress and stress
hormones may be advantageous to facilitate fear extinction
processes.
Objectives and Methodology: We used an aversive
differential conditioning paradigm with a 24-delay between
acquisition (day 1) and extinction I (day 2) and extinction
II (day 3) to investigate stress effects on fear memory
retrieval and extinction independent of stress effects on
memory acquisition/consolidation. Cold pressure stress
test (CPS) was used to induce stress before retrieval/
extinction on day 2. There was no stress manipulation
on day 3 to test the prolonged effects of stress before
extinction on day 2. Neutral geometrical figures were used
as conditioned stimuli (CS+, CS-), an electrical stimulus
as unconditioned stimuli (US). Dependent variables were
skin conductance response (SCR), US-expectancy, CS
valence and the anxiety evoked through the CS.
Results: We found a significant (p < 0.05) stress effect on USexpectancy retrieval on day 2, but only in male participants.
No effects of stress on extinction on day 2 and no prolonged
effects on day 3 could be detected. SCR, CS valence and
anxiety results will be presented as well.
Discussion and Conclusion: The results of this study
suggest that stress can hinder fear memory retrieval as
measured with US-expectancy in an aversive differential
conditioning paradigm. In our study, this stress effect was
only observed in males, which might be due to a more
pronounced cortisol reaction to the CPS as compared to
women.
80
Symposium 28 - Effectiveness studies
in anxiety disorders for children and
adults
S28-01
Stepped care vs. direct CBT for social anxiety
disorder or panic disorder: A randomised
controlled trial
Tine Nordgreen1; Thomas Aug1; Tone Tangen1; Ole-Johan
Hovland1; Per Carlbring2; Gerhard Andersson2; Gerd
Kvale1; Gerd Öst1; Einar Heiervang1; Odd Havik1
1
University of Bergen, Norway; 2Linköping University,
Sweden
Background: The aim of present study was to answer
the following research questions: Is a stepped care
treatment model for social anxiety disorder (SAD) and
panic disorder (PD) based on cognitive behaviour therapy
(CBT) as effective as 12 sessions manualized CBT? Were
the patients who received high-intensity intervention in the
stepped care treatment demoralised as they did not benefit
from low-intensity interventions?
Methods: Nine outpatient clinics were recruited into
the study, including 10 independent assessors and 20
therapists. Patients were randomised to either stepped
care or direct 12 sessions face-to-face manualized
CBT. The stepped care treatment involved three steps:
Psychoeducation (one session), guided Internet-based
self-help (9/ 10 weeks), and 12 sessions face-to-face
manualized CBT. Patients in the stepped care condition
who did not achieve clinically significant improvement
after low-intensity interventions were offered high-intensity
intervention. Main outcome measurers included clinical
severity rating and drop-out after each intervention.
Results: A total of 172 patients were included. Results
show no difference in the proportion of patients who
achieved clinically significant improvement after the
stepped care and direct 12 session model for PD. However,
more PD patients dropped out of the stepped care
treatment. For SAD, there was no significant difference
between the two treatment models regarding clinically
significant improvement and drop-out. One year follow-up
results will also be presented.
EABCT 2012
Stepped care CBT vs. direct CBT for panic
disorder and social phobia: Outcome and
predictors.
Thomas Haug1,2, Tine Nordgreen1, Lar-Göran Öst1,2, Odd
Havik1
1
University of Bergen, Norway; 2Haukeland University
Hospital, Bergen, Norway; 3Stockholm University,
Sweden
Background: The effect of both face-to-face CBT and
guided self-help (GSH) for social phobia and panic
disorder is well documented through numerous RCTs and
meta- analyses. However, in the research literature it has
been highlighted a need for more research on issues related
to dissemination of CBT to ordinary clinics. One way to
address these issues is through effectiveness studies
conducted in ordinary clinical settings. In addition there is
a need to examine potential predictors and moderators for
treatment effect, so that patients expected to benefit from
different treatments can more easily be identified.
Sample: 176 patients from ordinary out patients
clinics, 105 with social phobia and 71 with panic
disorder, were randomized to direct face-to-face CBT or
a CBT based stepped care model consisting of 1.5 hour
psychoeducation, 9-10 weeks of GSH through the Internet
and 12 weeks of manualized face-to-face CBT, identical to
the direct CBT condition.
Patients were assessed before treatment and after each
treatment with structured clinical interviews and different
self- report questionnaires.
Objective: This presentation compares the outcome
and predictors of effect of stepped care CBT and direct
manualized face-to-face CBT for panic disorder and
social phobia. The following research questions will be
addressed:
1) Are there differences in mean effect-sizes between the
“low intensity” (psychoeducation + guided self- help) part
of the stepped care model and direct face- to- face CBT? 2)
Which factors are associated with the treatment outcome?
3) Are different predictors contributing to outcome of “low
intensity” CBT and direct face-to-face CBT?
Results: Preliminary results post-treatment indicate
that in general there are no mean differences in outcome
between direct face-to-face CBT and low-intensity
CBT for panic disorder or social phobia. Potential
predictors and moderators such as personality disorders,
comorbidity, socio-demographic factors, motivation
and interpersonal problems will be investigated through
correlation and multiple regression analyses. Results and
implications will be discussed.
Process factors as predictors of outcome in a
large CBT trial
Krister Fjermestad1; Gro Wergeland3; Lars-Göran Öst1,2;
Odd Havik1; Einar Heiervang3
1
University of Bergen, Norway; 2Haukeland University
Hospital, Bergen, Norway; 3University of Oslo, Norway
EABCT 2012
Introduction: The effect of CBT for anxiety disorders
is well-documented but less is known about the factors
involved in causing the effect.
Objectives and Methodology: The aim is to document
predictors of outcome in a large randomized controlled trial
comparing individual CBT (ICBT), group CBT (GCBT), and
waitlist. The treatment program is the manual-based CBT
program (“Friends for life”, Barrett et al., 2001) applied in
regular youth mental health clinics in Norway. The sample
(181 youth, mean age 12.4, 46.9% boys) had social
phobia, separation anxiety, and/or generalized anxiety
disorder at intake. Anxiety and depression symptoms
were measured before and after treatment and at oneyear follow-up. Pretreatment motivation and perceived
treatment credibility was measured at intake, and alliance
was measured during treatment.
Results: About half the sample lost their primary
diagnosis, and effect sizes were medium to large for anxiety
and depression symptoms. Hierarchical Linear Modelling
analyses showed that all process factors contributed to
effects of the treatment, although some effects were small.
Effects were stronger for ICBT than for GCBT.
Discussion and Conclusion: This presentation provides
important information about predictors of treatment effects
in CBT. Addressing motivation and perceived treatment
credibility, and strengthening alliance may be useful tools
to optimize CBT for anxiety in youth.
81
28
S28-03
Symposium
S28-02
S28-04
Predictors of treatment dropout
Gro Wergeland1; Krister Fjermestad2; C. Marin3; Wendy K
Silverman3; Odd Havik2; Einar Heiervang4
1
University of Oslo, Norway; 2University of Bergen,
Norway; 3Florida International University, USA;
4
University of Oslo, Norway
Symposium
30
Premature treatment termination is common in public
child mental health clinics. Little is known about factors
associated with premature termination among children
with anxiety disorders. This study examines predictors of
dropout from a 10 week randomized controlled effectiveness
trial of a group (GCBT) versus individual (ICBT) cognitive
behavior therapy program conducted in seven public mental
health outpatient clinics in Norway. Participants were
children (N= 182, ages 8-15, M = 11.5, SD = 2.1) with a
primary diagnosis of separation anxiety disorder, social
anxiety disorder or general anxiety disorder (85.7 % (n =
156) completers, 14.3% (n = 26) dropouts). Dropout rates
were similar in ICBT and GCBT. Overall, there were few
differences between the completers and non-completers,
both with respect to demographic and clinical characteristics.
However, baseline scores of child-rated perceived treatment
credibility (TC) and self concept, as well as parent-rated
TC and youth inhibited temperament significantly differed
between completers and non- completers. Only child-rated
TC significantly predicted dropout with an OR = 0.845, 95%
CI: 0.770, 0.927, p<0.0005. The most frequently patient
reported reason for dropout was low motivation for therapy.
Implication of these findings for future research and clinical
practice will be discussed.
82
Symposium 29 - Special Interest Group
(SIG) - Interactive session: A talk on
future direction of a common program
project
Speakers: Steven Jones, Nikolas Nikolaidis, Antonio
Pinto00 – 17h30
Symposium 30 / GERMAN
Room 13
Symposium 30 - Herausforderungen und
neue Entwicklungen in der Kognitiven
Remediationstherapie bei schizophren
Erkrankten
S30-01
Veränderungsmechanismen der kognitiven
Remediationstherapie bei schizophren
Erkrankten
Stefanie J. Schmidt1; Daniel R. Mueller1; Volker Roder1
1
Universität Bern, Switzerland
Einleitung: Psychosoziale Beeinträchtigungen gelten als
zentrales diagnostisches Merkmal für eine schizophrene
Erkrankung. Sie bestehen oft trotz Symptomremission
und trotz der Entwicklung von neuen psychosozialen
und medikamentösen Behandlungsansätzen fort. Eine
kürzlich publizierte Metaanalyse spricht für die Bedeutung
von sozialen Kognitionen, Negativsymptomatik sowie
der vorhandenen sozialen Fertigkeiten als Mediatoren
der Beziehung zwischen Neurokognitionen und dem
psychosozialen Funktionsniveau. Bislang wurden jedoch
in keiner Studie diese Variablen zu unterschiedlichen
Messzeitpunkten erhoben, um die postulierte zeitliche
Anordnung im Mediatormodell zu untersuchen.
Untersuchungsgegenstand und Methode: Die Daten
wurden im Rahmen einer internationalen randomisierten
Multicenterstudie erhoben, in der die Wirksamkeit der
Integrierten Neurokognitiven Therapie (INT) im Vergleich
zur Standardbehandlung (Treatment as Usual) untersucht
wurde. 169 ambulante Patienten mit der Diagnose einer
Schizophrenie (DSM-IV-TR) nahmen an der Studie teil. Das
Modell wurde separat für die INT (n=86) und die TAU Gruppe
(n=83) analysiert. Dabei kam ein längsschnittliches Design
mit drei Messzeitpunkten (Baseline: Neurokognitionen; T1,
nach 3 Monaten/nach der Therapie: soziale Kognitionen,
Negativsymptomatik, soziale Fertigkeiten; T2, nach einem
Jahr: psychosoziales Funktionsniveau) zur Anwendung.
Basierend auf früheren Forschungsergebnissen wurde
zunächst ein Pfadmodell getestet, in dem alle Variablen
miteinander verbunden waren. Anschliessende Posthoc Modifikationen basierten auf Theorie, ModellgüteStatistiken und der statistischen Signifikanz jedes Pfads.
EABCT 2012
Kognitive Defizite bei schizophren Erkrankten:
Vergleich der Wirksamkeit eines Trainings
zum Problemlösen und einem Training basaler
Kognition
Kathlen Rodewald1, Mirjam Rentrop1, Daniel V.
Holt1, Daniela Roesch-Ely1, Joachim Funke1, Steffen
Aschenbrenner2, Dennis Gmehlin2, Matthias Weisbrod1,2,
Stefan Kaiser3
1
Universität Heidelberg, Germany; 2SRH Klinikum
Karlsbad-Langensteinbach, Germany; 3Psychiatrische
Universitätsklinik, Zürich, Switzerland
Einleitung: Schizophrenie ist durch schwerwiegende
Störungen des Denkens, der Wahrnehmung und der
Gefühle charakterisiert. In den neunziger Jahren des
vorherigen Jahrhunderts wurde die zentrale Bedeutung
kognitiver Defizite für den Verlauf und die Prognose
der Schizophrenie erkannt und ihre Bedeutung für
die Therapie zunehmend betont. So gehen kognitive
Defizite u.a. mit einem geringeren psychosozialen
Niveau und einer eingeschränkten Lebensqualität
einher. Die medikamentöse Behandlung kognitiver
Defizite im Rahmen schizophrener Erkrankungen ist
weiterhin unbefriedigend. Daher kommt psychosozialen
Trainingsprogrammen, mit deren Hilfe neben kognitiven
vor allem soziale Fertigkeiten eingeübt und erlernt
werden und speziellen kognitiven Trainingsprogramme,
die unmittelbar die kognitiven Leistungsverbesserung
anstreben, eine zentrale Bedeutung in der Behandlung
schizophrener Störungen zu.
Untersuchungsgegenstand: Wir berichten über
eine BMBF geförderte Studie, die die Wirksamkeit
zweier kognitiver Trainingsverfahren mit Interventionen
auf unterschiedlichen Komplexitätsebenen und
relevante Prädiktoren für den Trainingsverlauf bzw.
EABCT 2012
83
30
S30-02
Veränderungen in der Kognition bei schizophren
Erkrankten überprüft und evaluiert. In der vorliegenden
Arbeit wurde ein computergestütztes kognitives
Trainingsverfahren eingesetzt, das in der einen Gruppe
die Problemlösefähigkeit, in der anderen Gruppe
basale Kognition - Aufmerksamkeit, Gedächtnis und
Reaktionsgeschwindigkeit - beinhaltete. Hierzu wurden
80 stationäre an Schizophrenie erkrankte Patienten
des SRH Klinikums Karlsbad-Langesteinbach im
Zeitraum zwischen September 2007 und Februar 2009
untersucht. Beide Gruppen nahmen drei Wochen lang
am kognitiven Training mit der RehaCom® Software
und der dazu parallel stattfindenden Arbeitstherapie
teil. Neben den Leistungsveränderungen in der
Arbeitstherapie wurden sowohl Veränderungen in den
Funktionsbereichen Arbeitsgedächtnis, Problemlösen,
Planen und Verarbeitungsgeschwindigkeit als auch
Veränderungen in der Psychopathologie erfasst.
Ergebnisse und Diskussion: Die hypothesengeleitete
Auswertung befasste sich mit der differentiellen
Wirksamkeit in Hinblick der unterschiedlichen
Trainingsverfahren für die Alltagsfunktion und die
Problemlöse- bzw. Planungsfähigkeit. Eine explorative
Auswertung zielte auf differentielle Effekte auf die basale
Kognition und die Identifikation von Modulatoren bzw.
Prädiktoren für den Trainingsverlauf und Veränderungen
in der neurokognitiven Leistungsfähigkeit. In Bezug auf
das „Primary Outcome“ (Arbeitsfähigkeit) zeigte sich
keine Überlegenheit eines der beiden Trainings im
Rahmen der Arbeitstherapie. Beide Trainingsgruppen
konnten bedeutsame Verbesserungen sowohl in
der O-AFP Subskala „Lernfähigkeit“ als auch in
der „Gesamtskala“ erzielen. In Hinblick auf das
„Secondary Outcome“ konnten trainingsspezifische
Effekte aufgezeigt werden: so konnte das Training der
Problemlösefähigkeit eben diese mehr verbessern als
ein Training der basalen Kognition. Die Verbesserungen
führten jedoch zu keiner Generalisierung auf
der horizontalen Ebene. Das Training der
Reaktionsgeschwindigkeit wiederum resultierte in
einer Überlegenheit der Vergleichsgruppe in Bezug auf
die genannte Fähigkeit. Auch hier fehlt allerdings die
horizontale Generalisierung auf das Arbeitsgedächtnis
und die Inhibitionsleistung. Nach ersten Analysen
scheint die Negativsymptomatik vor Beginn des
Trainings den Trainingsverlauf vorherzusagen,
wohingegen die neurokognitive Leistungsfähigkeit vor
Trainingsbeginn die Veränderungen in der Kognition
entscheidend beeinflusst.
Symposium
Ergebnisse: Soziale Kognitionen, Negativsymptomatik
und soziale Fertigkeiten in der Gruppe fungierten als
Mediatoren zwischen Neurokognitionen und dem
psychosozialen Funktionsniveau in der INT Gruppe. Alle
indirekten Pfade waren signifikant. Das Modell wies eine
sehr gute Passung mit den Daten auf. In der TAU Gruppe
konnte das Mediatormodell dagegen nicht bestätigt
werden.
Diskussion und Schlussfolgerungen: Die Ergebnisse
dieser Studie liefern weitere Evidenz für integrierte
Behandlungsprogramme für schizophren Erkrankte.
Soziale Kognitionen, Negativsymptomatik und soziale
Fertigkeiten stellen wichtige Therapieziele dar, um die
aktuell vorhandenen kognitiven Remediationsansätze zu
optimieren und die Generalisierung der Therapieeffekte
auf den Lebensalltag zu fördern.
S30-03
Symposium
30
Therapie sozial-kognitiver Defizite bei
schizophren kranken Straftätern: Die
Wirksamkeit des Trainings der Affektdekodierung
(TAD)
Nicole Frommann1; Christian Luckhaus1; Wolfgang
Wölwer1
1
Heinrich-Heine-Universität, Düsseldorf, Germany
Störungen sozial- kognitiver Funktionen, insbesondere
Defizite in der Dekodierung des mimischen Affekts sind bei
schizophren Kranken gut bekannt und bisherigen Studien
zur Folge durch das Training der Affektdekodierung
(TAD) der Remediation zugänglich. Das TAD wurde als
spezifische Intervention zur Remediation von Störungen
der Affektdekodierung bei schizophren Kranken
entwickelt und in der Allgemeinpsychiatrie evaluiert.
Der Affektdekodierung wird eine Schlüsselfunktion in
der sozialen Interaktion zugeschrieben und Störungen
scheinen bei schizophren Kranken, die aufgrund von
Gewaltanwendung forensisch untergebracht sind, von
besonderer Relevanz zu sein. In zwei Untersuchungen
konnte nun gezeigt werden, dass das TAD auch bei
schizophren Kranken mit Gewaltdelikten und im Rahmen
der Behandlungsbedingungen des Maßregelvollzugs mit
Erfolg eingesetzt werden kann. Ferner konnte in diesem
Rahmen die Stabilität des Trainingseffektes über den
bisher längsten katamnestischen Zeitraum von 2 Monaten
nachgewiesen werden.
S30-04
Integrierte Neurokognitive Therapie (INT)
für schizophren Erkrankte: Evidenz und
Implementierung
Daniel R. Müller1; Stefanie J. Schmidt1; Volker Roder1
1
University of Bern, Switzerland
Einleitung: Vor acht Jahren hat die amerikanische
NIMH-MATRICS-Initiative sechs neurokognitive und
fünf sozialkognitive Funktionsbereiche definiert, die zur
Behandlung schizophren Erkrankter relevant erscheinen
und heute international als Standardzielbereiche
für pharmakologische und psychotherapeutische
Interventionen gelten.
Untersuchungsgegenstand: die neu entwickelte
Integrierte Neurokognitive Therapie (INT) entstand im Zuge
der Weiterentwicklung der kognitiven Unterprogramme
des Integrierten Psychologischen Therapieprogramms
(IPT). Die INT ist ein kognitiv-verhaltenstherapeutischer
Gruppentherapieansatz, der erstmals sämtlichen
84
11 MATRICS-Dimensionen in ein einheitliches
Therapiekonzept integriert. Die INT setzt sich aus vier
aufeinader aufbauenden Therapiemodulen zusammen,
die jeweils neuro- und sozialkognitive Interventionsziele
enthalten. Das ressourcenorientierte Vorgehen der INT
beinhalten motivationsfördernde edukative Elemente,
PC-gestützte Übungen und das Etablieren von
Kompensationsstrategien zur Optimierung des kognitiven
Funktionsniveaus. Mit dem konsequenten Einbezug des
individuellen Alltagserlebens wird eine Generaliserung
der Effekte über die Therapie hinaus im sozialen Kontext
angestrebt.
Methode: In einer internationalen Multicenterstudie, an
der 8 Zentren in der Schweiz, Deutschland und Österreich
teilnehmen, konnten insgesamt 169 ambulante Patienten
mit der Diagnose Schizophrenie nach ICD-10 entweder der
INT oder einer Kontrollbedingung mit Standardbehandlung
(TAU) zufällig zugewiesen werden. Die Therapiephase
dauerte 15 Wochen mit 30 Sitzungen zu 90 Minuten.
Eine umfangreiche Testbatterie wurde vor und nach der
Behandlungsphase sowie nach einer Einjahreskatamnese
erhoben.
Ergebnisse: Die INT erzielte positiven Effekte in kognitiven
Zielvariablen im Vergleich zu TAU, welche während der
Einjahreskatmnese aufrechterhalten werden konnten.
Diese objektiv erhobenen Testergebnisse stimmten mit
einer veränderten subjektiven Wahrnehmung selbsterlebter
kognitiver Funktionsdefizite der Patienten überein.
Zusätzlich zeigten sich signifikante Verbesserungen
in den Sekundärbereichen Negativsymptomatik und
psychosoziales Funktionsniveau. Die geringe Anzahl
von 10.3% Studienabbrechern unter INT sowie die hohe
Sitzungsteilnahmefrequenz von 81.1% bestätigt die hohe
Therapieakzeptanz der Patienten.
Diskussion: die Ergebnisse belegen die Wirksamkeit
der INT in den primären kognitiven Zielbereichen sowie
in weiteren, sekundären Zielbereichen. Die klinische
Implementierung der INT in unserer Klinik bestätigte
sowohl die grosse Akzeptanz seitens der Patienten als auch
die starke Nachfrage zuweisender Behandler, namentlich
niedergelassenen Therapeuten.
Schlussfolgerung: Die sowohl evidenz- als auch
bedarfbasierte INT kann als Beispiel einer integrierten
kognitiven Remediationstherapie innnerhalb einer
multimodalen Behandlung schizophren Erkrankter
eingesetzt werden.
EABCT 2012
TCC en groupe pour patients souffrant
d’hyperphagie boulimique
Murielle Reiner1
1
Hôpitaux Universitaires de Genève, Switzerland
Sur un modèle de thérapie de groupe de W.S.Agras, une
TCC de groupe de 16 séances hebdomadaires (dont
une séance animée par une arthérapeute et une par un
diététicien) est présentée de sa mise en place à son issue. Si
les aspects comportementaux et cognitifs visent tous deux
une meilleure adaptation du patient et de son comportement
alimentaire, ils passent par des chemins différents. Au
niveau comportemental on fait appel tout au long des 16
séances au carnet alimentaire, afin de favoriser la prise de
conscience du comportement alimentaire et des liens avec
des événements extérieurs ainsi qu’intérieurs (émotions).
Par ailleurs, dans ce volet comportemental on s’intéresse
aussi au réapprivoisement des sensations digestives et à
la réintroduction d’aliments «interdits». Au niveau cognitif
l’on vise la familiarisation avec les notions d’émotion,
pensée, comportement et sensation physique ainsi que la
compréhension des relations et des influences réciproques
entre ces instances. Par la suite, un travail de restructuration
cognitive est proposé autour de déclencheurs émotionnels,
situationnels ou cognitifs repérés par les patients.
Les points saillants de la prise en charge seront explicités
ainsi que les outils principaux. Lors de la discussion les
participants pourront partager leur éventuelle expérience de
thérapie de groupe similaire ou poser des questions sur la
mise en ouvre d’une thérapie de ce type.
EABCT 2012
Description d’un programme d’intervention
visant une amélioration des compétences en
termes d’ouverture émotionnelle et de régulation
des émotions
Stéphanie Haymoz1; Michaël Reicherts1
1
University of Fribourg, Switzerland
Introduction: Le rôle du traitement affectif, notamment
de la régulation des émotions, a été identifié comme étant
central dans les domaines de la santé physique et psychique
(Gross, 2007). Différents prog rammes d’intervention ont
été développés mais peu reposent sur un modèle du
traitement émotionnel empiriquement validé. Objectifs :
Sur la base du modèle de l’ « Ouverture Emotionnelle »
(Reicherts, Genoud & Zimmermann, 2011), nous avons
développé un programme d’intervention manualisé de 6
séances (Reicherts, Haymoz & Hulmann, 2008) destiné
à des groupes de participants tout-venant dans le but
d’accroître leur ouverture émotionnelle et rendre plus
fréquentes et efficaces les techniques de régulation des
émotions dites adaptées.
Méthode: 36 sujets, randomisés dans deux conditions
groupales (Groupes en attente de traitement versus
Groupes d’intervention), ont été mesurés à au moins 3
reprises avec des instruments portant sur le traitement
affectif (DOE-Trait, Reicherts, 2007) et la régulation des
émotions (DOE-IT, Reicherts & Haymoz, 2009; CERQ;
Garnefski, Kraaij & Spinhoven, 2001; DERS; Gratz &
Roemer, 2004; ERQ; Gross & John, 2003).
Résultats: Comparativement au groupe contrôle, le
groupe expérimental montre plusieurs changements, mis
en évidence par des modèles hiérarchiques linéaires.
Discussion : Les changements observés répondent aux
hypothèses et représentent une amélioration du traitement
affectif et des techniques de régulation. Ces résultats
encourageants soulignent l’importance de travailler sur les
tendances d’un individu à être ouvert à son vécu affectif et
à le réguler plus adéquatement.
Conclusion: Afin d’avoir une vision plus différenciée
de l’efficacité de notre programme, nous souhaitons
tenir compte de la perception qu’ont les participants des
facteurs thérapeutiques mobilisés dans nos groupes
d’intervention. Nous projetons également d’adapter et
d’appliquer ce programme dans différents domaines de la
psychologie clinique et de la santé.
85
31
S31-01
S31-02
Symposium
Symposium 31 - Au-delà des TCC en
individuel
S31-03
Symposium
31
Regards croisés sur les groupes de proches et
de patients borderline
Virginie Salamin1
1
Réseau fribourgeois de santé mentale, Switzerland
D’après Marsha Linehan (1993), le trouble de la
personnalité borderline résulte de l’interaction de
facteurs d’ordre biologique (vulnérabilité émotionnelle)
et de facteurs environnementaux (l’environnement
invalidant).L’hypersensibilité de l’enfant, dans un
environnement qui ne valide que peu/pas les émotions,
se trouve progressivement accentuée. L’enfant n’apprend
pas à étiqueter son vécu émotionnel, le réguler, ni même le
communiquer de manière adéquate. La théorie biosociale
permet d’expliquer aux patient-es, mais également à leurs
proches, le développement et le maintien du trouble de
personnalité borderline. La famille et les proches de ces
patients font partie de leur environnement immédiat, mais
les difficultés de ces patients se retrouvent évidemment
dans d’autres contextes. Qu’ils soient destinés aux patientes borderline ou à leurs proches, les groupes psychoéducatifs selon l’approche comportementale dialectique
offrent un cadre idéal de non-jugement pour réfléchir non
seulement à l’étiologie du trouble, mais également aux
concepts dialectiques de l’acceptation et du changement.
Dans cette présentation, nous allons tenter mettre en
parallèle deux groupes, le groupe d’entraînement aux
compétences pour les patient-es borderline (Linehan,
2000), et le groupe « Connexion familiale » pour leurs
proches (Hoffman et al., 2005, Fruzzetti, 2009), et
porter des regards croisés sur la théorie biosociale et
l’environnement invalidant, l’acceptation, le changement
et la validation de soi et de l’autre.
S31-04
Transition de Carrière: Approche cognitive et
comportementale (ACC), Pleine Conscience
(PC) et Psychologie Positive (PP). Comment et
Pourquoi cela marche !
Marion Aufseesser1
1
Private practice, Geneva, Switzerland
Introduction: La perte de l’emploi et le chômage figurent
en tête des facteurs de stress dans la plupart des pays
d’Europe occidentale.
Objectif: Ma présentation a pour but d’illustrer les
bénéfices d’une approche d’assistance en transition de
carrière basée sur l’ACC, la PC et la PP.
Méthode: Développée depuis plus de 15 ans, cette
approche trouve sa base scientifique dans des rapports
86
tel que le HIRES (Health in Restructuring: Innovative
Approaches and Policy Recommendations), un projet
mis en place par la Direction Générale du “Employment
of the European Commission” (Rainer Hammp Verlag)
et dans l’approche innovatrice du Professeur A. Grant
(Université de New South Wales - Australie). L’approche
proposée permet aux candidats: • d’aborder de manière
concentrée et réaliste la phase de leur transition de carrière
• de lâcher prise pour atteindre la phase de l’acceptation
• de rapidement prendre un rôle pro-actif pendant la
phase de transition • de reprendre de la confiance en soi
et de l’estime de soi • de construire un nouveau projet
professionnel • de chercher activement un nouvel emploi
Résultats: La plupart des candidats ayant suivi avec
motivation les programmes individuels ou en groupe disent
avoir pu aborder le marché très compétitif de l’emploi, de
manière plus positive et sereine, grâce à une confiance et
une estime de soi accrues. Un grand nombre d’entre eux
ont retrouvé un travail stable. Conclusions: Sur la base de
mon expérience, il semblerait qu’une approche combinant
ACC, PC et PP, alliée à des techniques plus classiques en
matière de transition de carrière, augmentent le taux de
retours à l’emploi des candidats, ainsi que leur confiance
en soi. Par ailleurs, il est possible que ces personnes
aient aussi une meilleure santé physique et psychique à
plus long terme. Enfin, cette approche ouvre de nouvelles
perspectives aux psychologues désireux d’oeuvrer dans
un domaine essentiellement préventif.
S31-05
Affirmation de soi: apports du travail en groupe
Giulio Corazza1
1
Private practice, Geneva, Switzerland
L’apprentissage des techniques de l’affirmation de soi peut
se pratiquer en individuel et en groupe, chaque approche a
ses avantages et ses inconvénients. Dans cette présentation
il sera développé les différents apports de la pratique des
méthodes de l’affirmation de soi en groupe.
EABCT 2012
Why “whys” seems better than “hows”, in
depressed people, in everyday life
Andrea Bassanini1; Gabriele Caselli2; Francesca Fiore1;
Giovanni M Ruggiero1; Sandra Sassaroli1; Edward
Watkins3
1
Studi Cognitivi Psychotherapy School and Research
Institute, Italy; 2London South Bank University, United
Kingdom; 3University of Exeter, United Kingdom
Introduction: Given the evidence for the dysfunctional
effects of rumination, the fundamental question remains:
why depressed patients continue to ruminate over long
periods of time?. Watkins has shown that unconstructive
Repetitive Thought is focused on “WHYs”, aiming at
detecting the personal reasons of negative events.
Objectives and Methodology: The research aims at a)
exploring the association between “WHYs” and “HOWs”
thinking style respectively and the emotional reaction in
everyday problems; b) exploring whether people tend to
prefer the WHY or the HOW when coping with unexpected
negative events; c) how people justify their preference for the
WHYs and/or the HOWs cognitive response. A sample of 212
participants has been recruited. We include questionnaires
about repetitive thought and depression and 8 pictures
describing negative unexpected situations, followed by three
tasks. Additionally, participants complete a mood check.
Results: The results confirm the detrimental role of why
focused repetitive thinking on mood state and show a
significant influence of the How/Why Style chosen in the
previous task on the next one.
Discussion and Conclusion: Results and implications
are discussed. In our opinion, this work has three original
aspects: a) We ask people to confront themselves with
everyday situations; b) We have clearly separated the HOW
and the WHY styles of thinking; c) We aim to analyse the
differences between metacognitive beliefs of the HOW and
the WHY styles.
EABCT 2012
Influence of stressful situations on drive for
thinness and bulimia
Francesca Fiore1; Sandra Sassaroli1; Giovanni M
Ruggiero1
1
Studi Cognitivi Psychotherapy School and Research
Institute, Italy
Introduction: Scientific literature suggests that stress is a
component of the process underlying the development of
eating disorders (ED).
Objectives and Methodology: This study explored
whether a stressful task increased measures of cognition
and behaviours related to eating disorder in non-clinical
individuals, and the relationship between control,
perfectionism, stress, and cognition related to ED using a
correlational methodology. Eighty non clinical individuals
participated in an experimental task implemented through
a personal computer. All individuals completed the Eating
Disorder Inventory before and after the task.
Results: Analyses showed a significant statistical
increase in average scores on the eating disorders
inventory measured before and after a stressful task, and
path analysis suggests two different cognitive models for
the mechanism leading to Drive for Thinness and Bulimia.
Discussion and conclusion: This finding suggests that
stress is an important factor in the development of Drive
for thinness and Bulimia.
S32-03
Beliefs over control and meta-worry interact with
the effect of intolerance of uncertainty on worry
Giovanni M. Ruggiero1; Lexine Stapinski2; Gabriele
Caselli1,3; Francesca Fiore1; Marcello Gallucci1; Sandra
Sassaroli1; Ronald M Rapee2
1
Studi Cognitivi, Psychotherapy School and Research
Institute, Italy; 2Macquarie University, Sydney, Australia;
3
London South Bank University, United Kingdom
Introduction: Cognitive theory conceptualizes worry as
influenced by metacognitive beliefs about worry, intolerance
of uncertainty, and perceptions of control over events and
reactions.
Objectives and Methodology: This study tests the
hypothesis that the effect of intolerance of uncertainty
would interact with meta-cognitive beliefs on worry and
perceived control. One hundred eighteen individuals with
generalized anxiety disorder and 54 controls completed
the Meta-Cognition Questionnaire, the Intolerance of
Uncertainty Scale, the Anxiety Control Scale, and the Penn
State Worry Questionnaire.
87
32
S32-01
S32-02
Symposium
Symposium 32 - Stress and perseverative
thinking styles across anxiety,
depression and eating disorders
Results: Models were tested measuring interactive effects
in multiple regression linear analysis. The interaction
model was confirmed. The effect of intolerance of
uncertainty on worry was increased by its interaction with
metacognitive and control beliefs.
Discussion and Conclusion: The finding emphasizes
the significant role of metacognitive and control beliefs
in the cognitive process that leads to the development of
worry.
S32-04
33
Symposium
Autonomic correlates of worry, distraction, and
reappraisal during a fear induction paradigm
Sandra Sassaroli1; Cristina Ottaviani2; Rosita Borlimi2;
Gabriele Caselli1; Irene Giardini1; Camilla Marzocchi1;
Valeria Nucifora2; Daniella Rebecchi1; Giovanni M
Ruggiero1; Gianni Brighetti2;
1
Studi Cognitivi, Psychotherapy School and Research
Institute, Italy; 2University of Bologna, Italy
Introduction: The cognitive avoidance model of worry
(Borkovec, 1994) assumes that worry has the adaptive
function to keep under control the physiological arousal
associated with anxiety.
Objectives and Methodology: Thirty-one pathological
worriers and 36 healthy controls accepted to be exposed
to a fear induction paradigm (white noise) during
three experimental conditions: worry, distraction, and
reappraisal. Skin conductance (SCR) and heart rate
variability (HRV) were measured as parameters of
physiological arousal.
Results: Worriers showed increased sympathetic
activation and autonomic imbalance, and decreased vagal
tone during worry compared to non-worriers. There were
no differences for the distract and reappraisal conditions.
When the temporal dynamic was analyzed, SCRs to the
white noises were higher in worriers vs controls throughout
the entire worry period. Only in pathological worriers,
intolerance of uncertainty and positive beliefs about worry
correlated with LF/HF-HRV during worry. In the entire
sample, somatization tendencies were associated with
increased vagal withdrawal and LF/HF-HRV during worry.
Discussion and Conclusion: Results support the
cognitive avoidance model in healthy controls, suggesting
that worry is no longer a functional attitude when it becomes
the default/automatic (and pathological) response.
88
Symposium 33 - A Large International
Collaboration on the Cross-Cultural
Study of Intrusive Thoughts: The
Development of the International
Intrusive Thoughts Interview Schedule
(IITIS)
S33-01
A Large International Collaboration on the
Cross-Cultural Study of Intrusive Thoughts:
The Development of the International Intrusive
Thoughts Interview Schedule (IITIS)
Adam S. Radomsky1
1
Concordia University, Montreal, Canada
A number of measures are available to assess intrusive
thoughts, however many of them are characterized
by concerns arising from the emphasis placed on the
respondants’ ability to differentiate between unwanted
intrusions, worry, rumination, and other mental activity.
Also it is likely that cultural values may shape the
experience and appraisal of such intrusions, resulting
in important differences in intrusive mental phenomen
aaround the world. For example do these intrusions differ
internationally in type, frequency, importance, distress,
and difficulty with suppression of the thought? The IITIS
was developed to answer these questions in the form of
gathering rich qualitative and quantitative information on
intrusions around the world. It assesses seven types of
fearful intrusive thoughts (contamination/disease, harm/
aggression, doubt, religious and morality concerns,
disgusting sexual matters, victim of violence, and other
idiosyncratic intrusions). Researchers from fourteen sites
across twelve countries (Argentina, Australia, Canada,
France, Greece, Hong Kong, Iran, Israel, Italy, Spain,
Turkey, and the United States) used trained administrators
to gather this data. This symposium will begin with a
presentation from the chair, Adam S. Radomsky and
Gillian M. Alcolado, on interesting similarities and
differences in the experience, expression and appraisal
of unwanted intrusive thoughts cross-culturally. It will
continue with highlights from the French data by Martine
Bouvard, from the Greek data by Gregoris Simos and from
the Turkish data by Mujgan Inozu. Finally we will conclude
with a talk by our discussant, Christine Purdon, a leading
international researcher on intrusive thoughts.
EABCT 2012
Intrusions Around the World: Cross-Cultural
Data from the International Intrusive Thoughts
Interview Schedule (IITIS)
Adam S. Radomsky1; Gillian M. Alcolado1; David A.
Clark2; Amparo Belloch3; and the Research Consortium
on Intrusive Fear
1
Concordia University, Montreal, Canada; 2University
of New Brunswick, Fredericton, Canada; 3University of
Valencia, Spain
Introduction: Although measures of intrusive thoughts
exist, concerns arise over respondants’ ability to discern
unwanted intrusions from worries, rumination and other
mental activity. Further there are reasons to suspect that
cultural values may impact the experience, expression and
appraisal of unwanted intrusive thoughts.
Objectives and Methods: This study used the recently
developed International Intrusive Thoughts Interview
Schedule (IITIS), administered by trained interviewers
internationally to better understand intrusions crossculturally. Participants were 612 undergraduates (68.6%
female; M age=22.39, SD=4.52 years) from 12 sites
across 10 countries around the world, including Argentina,
Australia, Canada, Greece, Hong Kong, Israel, Italy, Spain,
Turkey, and the United States. The IITIS assesses seven
types of fearful intrusions (disease, harm, doubt, religious
and morality concerns, disgusting sexual matters,
victim, and other idiosyncratic intrusions). Perceived
consequences of the intrusion, frequency, importance,
distress and difficulty controlling it were assessed, along
with thought appraisal and control questions.
Results: Ninety-two percent of the sample endorsed at
least one type of intrusion (M=2.87). The most common
intrusion type was doubt, and the least common was sexrelated. Interesting differences emerged between countries
(e.g., Greeks reported no sexual intrusions; Turks reported
the highest number of religious intrusions). Appraisals
and control attempts of thoughts were predictive of the
intrusion frequency, importance, distress, and difficulty
controlling them. Detailed results will be presented along
with the IITIS development.
Discussion: Results will be framed in terms of the
assessment, conceptualization and treatment of intrusions,
as well as the cross-cultural factors that may play a role
therein.
Conclusion: The IITIS is a useful interview that provides
a solid understanding of the nature of intrusive thoughts
cross-culturally.
French data on the International Intrusive
Thoughts Interview Schedule (IITIS)
Martine Bouvard1
1
University of Savoie, Chambéry, France
EABCT 2012
Introduction: Cognitive appraisals of threat or danger in
response to specific stimuli (e.g., intrusions) are thought
to underlie the universal experiences of fear and anxiety.
The nature of these appraisals determines whether or not
an individual experiences problematic emotional and/or
behavioural responses to specific intrusions. Despite the
fact that a robust literature shows that intrusive thoughts
are central to OCD and other anxiety problems, we do not
yet know how similar and different these thoughts are
across cultures.
Objectives and Methods: The psychometric properties of
the French translation of the IITIS were investigated in a nonclinical sample. The participants were 90 undergraduate
student volunteers enrolled at the University of Savoie.
Five trained research assistants collected the data using
the interview. Additional self-report questionnaires were
administered measuring OCD, depressed, stressed, and
anxious symptomatology.
Results: Results reveal that the IITIS is a useful interview,
and that French participants reported a range of intrusive
thoughts in categories similar to those established in OCD
samples.
Discussion: Results will be discussed in terms of the
assessment of intrusive thoughts, and in terms of a large
cross-cultural international study.
Conclusion: The IITIS is a useful interview for use in the
French population. The nature of intrusive thoughts in this
population is largely consistent with our understanding
of intrusive thoughts as generated by North American
investigations.
89
33
S33-03
Symposium
S33-02
Symposium
33
S33-04
S33-05
Unwanted intrusive thoughts: Self-report vs
interview based assessment
Gregoris Simos1; Evangelos Ntouros1
1
University of Macedonia, Thessaloniki, Greece
Introduction: Normal obsessions or unwanted intrusive
thoughts (UIT) seem to be experienced by 80% to 90%
of the general population. Although UIT are a common
phenomenon, there is not a consensus on the best way to
assess them.
Objectives and Methodology: The aim of the present
study was to comparatively evaluate the use of a self-report
measure and an interview-based measure of UIT. The selfreport Symptom Checklist of the Yale-Brown Obsessive
Compulsive Scale (Y-BOCS-SC) and the self-report
Yale-Brown Obsessive Compulsive Scale (Y-BOCS) were
administered to 36 undergraduate students along with the
International Intrusive Thoughts Interview Schedule (IITIS).
The IITIS is a structured interview that assesses intrusive
thoughts and related constructs; it focuses on six main
categories of unwanted thoughts, and is designed to be
used with community.
Results: Concerning IITIS responses, 81% of participants
reported UIT from at least one category; the most frequent
UIT were those related to doubt (53%), being a victim of
violence (25%), and contamination/disease (22%), with
36% reporting only one type of UIT and 31% two types.
The mean number of obsessions reported in the Y-BOCSSC was 5.7, and 83% of participants endorsed at least
one UIT. Participants who reported UIT of contamination/
disease, harm/injury/ aggression, doubt, sex, religion
or being a victim of aggression were not significantly
different in Y-BOCS-Obsessions and YBOCS-Compulsions
scores, or total number of Y-BOCS-SC obsessions or
compulsions from those who denied having the above kind
of UIT. Separate analyses on the relationship of the different
intrusive thoughts categories to the Y-BOCS-SC categories
or Y-BOCS scores revealed significant similarities and
differences.
Discussion and Conclusion: Present results point to the
utility of both self-report and interview-based assessments
of UIT, although one has to take into consideration both the
pros and cons of each measure.
Unwanted Mental Intrusions: A Cultural
Comparison of Turkish and Canadian Students
Mujgan Inozu1; David A. Clark2
1
Dogus University, Istanbul, Turkey; 2University of New
Brunswick, Fredericton, Canada
Introduction: It has been suggested that cultures that
emphasize a narrow range of acceptable thinking or that
emphasize need to control unwanted or “bad” intrusive
thoughts (ITs), might influence how individuals evaluate
and attempt control over unwanted ITs.
Aims: The present study examined the cross-cultural
differences in the frequency, content, appraisal and control
of unwanted ITs using a nonclinical undergraduate sample
from Turkey and Canada.
Method: 55 Canadian and 51 Turkish undergraduates
completed a battery of standardized questionnaires of
anxious, depressive, and obsessional symptoms as well
as threat and safety values (TSV), and dysfunctional
beliefs. In addition, each students was administered a
detailed structured interview that assessed 7 types of ITs.
Results: Group differences in TSV indicated that the
most striking difference was observed in the religion and
sexual value scores: Turkish students scored higher than
their Canadian counterparts. The results of the interview
schedule indicated that a similar majority of Canadian and
Turkish students experienced at least one IT in the last three
months. Significant differences were evident in content,
with more Turkish students having unwanted religious
intrusive thoughts, and Canadians more immoral and
doubt intrusions. Overall, the Turkish sample generated
significantly higher appraisal ratings of perceived threat,
responsibility and intolerance to distress, whereas the
Canadian group showed higher appraisal ratings of
importance of thoughts. Finally, the Turkish individuals
used significantly more checking, neutralization, and
avoidance than the Canadians.
Conclusions: Although ITs are almost universal, the
content of intrusions, specifically religious and harm/
aggression ITs, have a strong cultural component. It is
also apparent that subtle differences exist in the appraisal
and control of ITs. Reasons for these cultural differences
and their implications are discussed in this presentation.
90
EABCT 2012
Experimental manipulation of emotion during
a writing task: Implication for the practice of
psychotherapy
Antonio Pascual-Leone1; Samantha Metler1; Terence
Singh1; Shawn Harrington1; Nikita Yeryomenko1; Martin
Crozier1; Fuschia Sirois1; Orrin-Porter Morrison1; Lisa
Porte1
1
University of Windsor, Canada
Introduction: Pascual-Leone and Greenberg’s (2007)
model showed that in therapeutic outcomes, key phases
of emotion were likely to emerge in a sequential pattern.
One question that followed was whether productive vs.
unproductive emotions were the product of therapist
interventions or if they reflected the inherent nature
of certain states as facilitative of change. This study
experimentally examines a key emotional process in
therapy by removing the influence of the therapist as a
collaborative meaning-maker.
Methods: The study follows seminal research of Pennebaker
and Beall (1986) on expressive writing, but uses priming
and process instructions to manipulate the specific types
of emotions being expressed over 3 writing session. 120
participants who reported recently suffering from traumatic
personal events were randomly assigned to 4 different
conditions that facilitated: (a) productive (primary adaptive)
emotion; (b) unproductive (secondary, primary maladaptive);
(c) a sequence of unproductive followed by productive
emotion (secondary, then maladaptive, then adaptive); or (d)
a control. Saliva cortisol samples were taken as in-session
measures of arousal. Intervention outcome was measured by
symptom changes 2 and 4 weeks post intervention.
Results: Interim analyses comment on: (1) the degree
to which productive vs. unproductive emotion could be
facilitated in the absence of a therapist (through priming
and instruction); (2) in-session arousal as measured by
saliva cortisol; (3) the relative outcome of experimental
conditions.
Discussion: This nature of emotional states (i.e.,
primary vs. secondary) is central to an emotion focused
theory of change but the findings have implications for
psychotherapy in general. This research comments on
identified therapeutic processes by subjecting them to
direct experimental manipulation
EABCT 2012
Experimental Manipulation of Affective-Meaning
States
Kristina Rohde1 Maria Stein2; Antonio Pascual-Leone3;
Franz Caspar1
1
University of Bern, Switzerland; 2University Hospital of
Psychiatry, Bern, Switzerland; 3University of Windsor,
Canada
Introduction: While many studies observed and tracked
emotional changes and their therapeutic effects, only few
researchers experimentally manipulated emotional change
processes (e.g. Pascual-Leone et al., 2011). In the longterm objective of developing experimental designs in
emotional change research, we explore not only ways of
descriptively tracking different emotional states but also
how they might be elicited under controlled conditions.
Pascual-Leone and Greenberg (2007) developed a model
of emotional processing that differentiates between
insufficiently processed emotional states (e.g. shame,
aggressive anger) and states of advanced processing (e.g.
assertive anger, self-soothing, grief). The authors refer to
these emotional states as affective-meaning states, none of
which are inherently pathogenic. However, perseverating or
recurring experiences of less advanced affective-meaning
states were shown to be less ‘productive’ i.e., associated
with poor within-psychotherapy session effects (PascualLeone, 2009).
Objective and Methodology: We investigated how
affective-meaning states could be primed in healthy
subjects suffering from unresolved negative feelings
towards a significant other, and secondly, we examined
the effects of such priming on emotional processing.
Participants who reported suffering from being hurt or
betrayed by a significant other were randomly assigned
to 2 different conditions that were supposed to prime
either relatively ‘productive’ affective-meaning states or
‘unproductive’, i.e. less processed affective-meaning
states. After being primed, the participants worked on their
personal experience of hurt or betrayal in an expressive
writing task and completed several self-report measures.
Results and Discussion: The results will be discussed
in terms of their implications for experimental research on
emotional change processes. Moreover, the applicability
of neurophysiological measures to this area of research
will be discussed.
91
34
S34-01
S34-02
Symposium
Symposiunm 34 - The role of discrete
emotions in the psychotherapeutic
intervention: clinical and experimental
research
Symposium
34
S34-03
S34-04
Effects of Motive-Oriented Therapeutic
Relationship on Emotional Processing in EarlyPhase Treatment for Borderline Personality
Disorder: An Exploratory Study
Laurent Berthoud1; Ueli Kramer1; Antonio Pascual-Leone2;
Franz Caspar3;
1
University of Lausanne, Switzerland; 2University of
Windsor, Canada; 3University of Bern, Switzerland
Introduction: Motive-Oriented Therapeutic Relationship
(MOTR; Caspar, 2007) has shown to be related to
therapeutic outcome, in particular in treatment facing
patients with Personality Disorders (Kramer et al.,
2011). However, a better understanding of the processes
involved in change is crucial (e.g., Pascual-Leone, 2009).
This exploratory study will examine the influence of the
therapist’s MOTR, based on the case formulation method
of Plan Analysis, towards the patient and focus especially
on the emotional processing of Borderline Personality
Disorder (BPD) in early-phase treatment.
Method: Two BPD outpatients – one from a 10-session
control condition (Gunderson & Links, 2008), the other
from a 10-session condition infused with MOTR – are
assessed using the Classification of Affective-Meaning
States (CAMS; Pascual-Leone & Greenberg, 2005, 2007).
Three sessions are examined for each patient: the intake,
the ones with the highest and the lowest score on the
alliance-level.
Results: Results of this exploratory study are promising
and show the applicability of emotional processing
variables to the psychiatric treatment frame with patients
presenting with BPD. Moreover, there are hints allowing
the hypothesis of better-quality emotional processing in
treatments involving MOTR.
Discussion: These findings have the potential in
contributing to the understanding of the change process
at play in the treatment of BPD.
Emotional Processing across Long-term
Psychotherapy in a Patient presenting with
Borderline Personality Disorder: A Case Study
Ueli Kramer1; Antonio Pascual-Leone2
1
University of Lausanne, Switzerland; 2University of
Windsor, Canada
Emotion-focused therapy is a well-validated treatment
form for different psychiatric disorders, in particular
problems related to depression and interpersonal trauma;
the use of emotion-focused techniques in the context of
borderline personality disorder has also been reported
(Warwar et al., 2008). The present case study presents a
patient who underwent an effective two-year-long emotionfocused therapy. Change in emotional processing will be
documented using the Classification of Affective Meaning
States (Pascual-Leone & Greenberg, 2005), applied pre-/
post to early and late sessions with the client. Results
show specific change processes across treatment, from
secondary emotions (i.e., global distress, rejecting anger)
to primary adaptive emotions (hurt/grief, assertive anger).
These results are discussed with regard to the model of
emotional processing (Pascual-Leone & Greenberg, 2007;
Pascual-Leone, 2009) and the specificities of change
processes in patient’s BPD undergoing emotion-focused
treatments.
92
EABCT 2012
Low Intensity CBT
Paul Farrand1
1
Exeter University, United Kingdom
The Improving Access to Psychological Therapies (IAPT)
programme has been implemented across England since
2008. It represents the first national programme to organise
and deliver evidence based psychological therapies for patients
with depression and anxiety within a stepped care model
of service delivery. Cognitive behavioural therapy features
prominently, with low intensity CBT being the only evidence
based ‘step 2’ intervention provided. This presentation
will address the role of low intensity CBT within the IAPT
programme. It will focus initially upon establishing what low
intensity CBT as employed within the IAPT programme is.
Issues regarding implementation, such as the development
of a new Psychological Wellbeing Practitioner workforce to
support the low intensity CBT interventions, national training
curricula and liaison with professional bodies to establish
course and practitioner accreditation processes, will then be
discussed. Finally results of several evaluations of the IAPT
programme (e.g. Clark et al, 2009; Richards & Borglin, 2011)
will be summarised before moving on to consider the nature
of future developments, alongside some of the challenges
faced, implementing and developing low intensity CBT.
S35-02
Brief CBT as guided self help program
Paul Rijnders1; Els Heene1,2; Nathalie Haeck1; Sara
Debruyne1,2
1
Indigo Zeeland, Rotterdam, The Netherlands; 2Ghent
University, Belgium
In cooperation with local GP’s a guided self-help program
was developed . It started with a program for adult patients,
in the mean time a comparable program is developed for
children. The program consists of 8 steps. Theses steps
are worked out in 8 chapters in a booklet the patient
uses while executing his/her treatment. Main focus is
on improving the coping repertoire. From that point of
view, the program is trans diagnostic. By means of shared
decision making, the patient is stimulated to act as cotherapist, carrying out treatment as much as possible on
his / her own. The therapist functions as coach. At the
symposium a brief overview is presented of the program,
as well as an overview of the results, for both groups.
EABCT 2012
Guided Self help by Internet
Bjorn Paxling1
1
Linköping University, Sweden
Treatments delivered partly or entirely over the Internet has
been developed in order to provide access to CBT to a
growing population despite a shortage of CBT-therapists.
Many of these treatment programs are delivered as
guided self-help with minimal contact with a trained
CBT professional, and some programs are also provided
without therapist contact, thus making them a digital/
interactive form of bibliotherapy. A range of different
e-health CBT-treatments are presented and the evidence
for these programs as well as thoughts on the future of the
field is discussed.
S35-04
Low intensity CBT and stepped care
Annemieke van Straten1
1
University of Amsterdam, The Netherlands
It is usually recommended not to offer low intensity
CBT as a ‘stand alone’ treatment but to include it in a
stepped care approach. In a stepped care approach most
patients start with a low intensity treatment and only
those who do not recover step up to a higher intensity
treatment (usually face-to-face treatment). Stepped care
is advocated in several clinical guidelines for depression
(e.g. the NICE guidelines). However, evidence about
the (cost)effectiveness of stepped care is still scarce. In
this presentation the key issues of stepped care will be
explained and the available evidence will be reviewed.
93
35
S35-01
S35-03
Symposium
Symposium 35 - Low intensity CBT: an
effective way to increase supply in
mental heath care
Symposium 36 - Understanding and
building good relationships with
patients who have severe mental health
disorders
S36-01
Symposium
36
CBT of psychoses: From the “acceptance” to the
mindfulness approach to overcome symptoms
Antonio Pinto1
1
Centreo di Psicoterapia cognitivo-comportamantale,
Naples, Italy
The treatment of Psychoses enjoyed in the last
years a substantial contribution from the insights of
the phenomenological and cognitive-evolutionary
approaches, enabling the identification of elements with
an adaptive meaning in the delusional ideations material,
as well as from the tools used by the traditional cognitivebehavioral approach, in the correction of dysfunctional
schemes and their related behaviors.
The original attempt to treat serious social-relational
impairment caused by psychoses in general (and
schizophrenia in particular), availing mainly of Social
skills Training does not seem to have led to significant
results, especially at long-term follow up.
Furthermore, despite encouraging results, not all patients
succeed in applying CBT techniques.
Many patients, in fact present a series of issues that thwart
treatment effectiveness, such as poor or absent illness
insight, mood instability, withering emotional intensity,
bizarre and hardly understandable behaviors )eventually
violent toward themselves and others), and resistant
positive symptoms. Furthermore the awareness of failure
in reaching some goal, could contribute to lower the sense
of self esteem and self efficacy.
One of the main problems identified in the treatment
of psychoses is, in fact the intersubjectivity impasse,
placing the person outside the interpersonal dimension
constituting the essential bases for the organization of any
psychotherapeutic intervention aimed at improving the
person’s overall quality of life.
In the last years, mindfulness and acceptance therapies
significantly contributed to promote the ultimate goal of
all medical and psychological treatments: easing patients’
suffering (Segal et al., 2002).
The acceptance of issues presented by the client and the
search for a meaning in the delusion must be presented as
essential milestones in the process of gaining the client’s
trust.
In fact, while psychotherapies help people solve, work on,
remove or better cope with what causes their suffering,
mindfulness introduces a new important element: helping
its practitioners and patients change their attitude toward
94
suffering and symptoms itself. It helps develop the
necessary skills to be less reactive to what is occurring
at the moment, allowing us to deal with different types of
experience in a way that lowers our levels of suffering,
while a sense of well-being is enhanced (Germer, 2005).
We will try to present the possibility to integrate this
approach, properly revised, within a CBT structured
treatment for psychotic patients.
S36-02
CBT for bipolar patients: How difficult is it to
build a goof and strong therapeutic relationship?
Nikolas Nikolaidis1
1
Aristotle University of Thessaloniki, Greece
Bipolar disorders are considered to be a frontier, in the
filed of CBT, both in research as well as in therapy per
se (Scott et al 2006; Lam et al 2005). Efforts made for
the conceptualization of the disorder, a consensus to the
description of the psychopathology (Johnson et al 2011),
and the research on the cognitive deficits of the patients
(Bozikas et al 2007) are not at an advanced level as one
could expect, comparing to other disorders. There is a
growing body of literature concerning underlying cognitive
structures (Earl Maladaptive Schemas, dysfunctional
attitudes, attachment style) (Moriss et al 2009; Ball et
al 2006; Hawke and Provencher 2011; Lam et al 2004;
Scott and Pope 2003) and difficulties in the therapeutic
relationship with bipolar patients. A review of this literature
will be discussed in the perspective o the newly proposed
model for bipolar disorder by Mansell, Morrison et al
(2007). A special focus is the therapeutic relationship with
these patients and their treatment non adherence.
S36-03
Neuroscience-based new methods for
assessment and treatment of schizophrenic
patients
Tullio Scrimali1
1
University of Catania, Italy
Neursocience-based new methods for assessment and
treatment of schizophrenic patients.
Schizophrenia is a very challenging disorder for any
therapist but in the field of Cognitive Therapy some
new procedures have been developed for its treatment.
Among them “Negative Entropy” is the protocol that Tullio
Scrimali developed and successfully applied for many
years (Scrimali, T (2008): Entropy of Mind and Negative
Entropy. Kamac, London). In this protocol one very original
and interesting aspect is that called Neuroscience-based
EABCT 2012
Building therapeutic relationship in order to
increase treatment adherence with schizophrenic
patients
Mehmet Sungur1
1
Marmara University, Turkey
Many studies find that about half of the people with
serious mental illness do not take their medications.
Within 7-10 days of medication following initiation 25%
of patients become noncompliant. After 1 year mediation
noncompliance rises to 50% and at the end of 2 years it
reaches 75%. Only 33% of the patients reliably take the
medication that are prescribed for them. Awareness of
being ill is one of the top predictors of long term medication
adherence in patients with schizophrenia. Unfortunately
poor Insight is a common symptom of the disorder.
Many patients to not accept that they are suffering from a
serious mental disorder and therefore do not accept to take
medication. The problem of poor insight and medication
refusal are two main problems that need to be addressed
in order to obtain a better chance of recovery. Another
major predictor of medication adherence is the therapeutic
relationship established with the patient. This presentation
aims to illustrate how to build collaboration, rapport
and good therapeutic relationships with schizophrenia
patients following a structured programme that increases
their motivation treatment adherence. The programme
includes components such as listening (L) reflectively,
expressing empathy (E) (including making empathy to
their unwillingness to take medication), finding something
to agree (A), and partnering (P) with the patient on goals
that can be worked out together. This programme known
as LEAP will be described and discussed.
EABCT 2012
S37-01
Guided internet-delivered treatment for social
anxiety disorder
Gerhard Andersson1
1
Linköping University and Karolinska Institute, Sweden
Introduction: Several studies have found that cognitive
behaviour therapy can reduce symptoms of social anxiety
in individuals with social anxiety disorder. However, there
are many who never get to see a skilled therapist and one
alternative is to provide the treatment from a distance via
the internet.
Objectives and Methodology: In this talk a summary
will be made of the controlled trials conducted on internet
treatment for social anxiety disorder.
Results: There are now more than 18 controlled trials
and most show results in line with what has been found
in face-to-face trials, with effect sized around d=0.80.
The results have been replicated by at least three different
research groups. Moreover, internet treatment is more
cost-effective and leads to improved knowledge about
social anxiety disorder and its treatment.
Discussion and Conclusion: Future challenges include
dissemination of the treatment into regular clinical
settings and training of therapists to provide the support.
Finally, mechanisms of change and predictors are largely
unknown.
95
37
S36-04
Symposium 37 - Disseminating internetbased psychological treatments:
Current challenges and future
directions
Symposium
which introduces some new techniques for assessing and
treating schizophrenic patients. During the presentation
Tullio Scrimali will describe the MindLAB Set, a new
computerized method he developed for monitoring of
exosomatic electrodermal activity and for applying a self
control method based on biofeedback. The assessment
of the skin conductance level is useful for monitoring the
patients’ arousal during the assessment and also across the
treatment as possible warning sign of relapse. Biofeedback
is a positive coping method the patients can easily learn
in order to become able to reduce his (or her) arousal and
better copying with stress. The results obtained with some
patients will be showed and discussed.
Symposium
37
S37-02
S37-03
Self-guided internet-based psychological
treatment for depressed patients awaiting
psychotherapy
Jan Philipp Klein1; Antje Roniger2; Fritz Hohagen1
1
Universität zu Lübeck, Germany; 2University of Freiburg,
Germany
Introduction: Depressed patients often have to
wait several months for their treatment, especially
psychotherapy. They suffer from a considerable symptom
load during this waiting period. Self-guided internet based
psychological treatments could be an easily accessible
treatment option in this setting. They have already been
shown to be effective in other settings.
Objectives and Methodology: The objective of this
study was to assess the efficacy of the self-guided internetbased psychological treatment Deprexis in patients
awaiting psychotherapy for depression. We randomized
200 patients suffering from major depressive disorder or
dysthymia (HAMD-24 > 10) to either Deprexis or waitinglist control. Patients were assessed with the 24-item
Hamilton-Depression Scale (HAMD-24) at baseline (T0),
six weeks (T1), end of treatment period (T2, minimum
of 12 weeks) and six-month follow-up (T3); numerous
other self- and clinician-rated questionnaires were also
completed. The main outcome measure was HAMD-24 at
T2.
Results: The study is currently underway and will be
completed in August 2012; T2 data for the full data set will
be presented at the symposium. Preliminary data from a
pilot study suggest that the recruitment target is realistic
and that, compared to a waiting-list control group, patients
receiving access to Deprexis experience a greater decrease
both in self- and clinician-rated depressive symptoms.
Discussion: Due to small sample size, the positive
results of the pilot study can only be regarded as a trend
and require confirmation. Since the main study presented
at the symposium is adequately powered, we expect to
be able to report statistically significant superiority of
Deprexis vs. the control condition in reducing both selfand clinician-rated symptoms of depression.
Conclusion: If the pilot data hold in the main study,
the self-guided internet-based psychological treatment
Deprexis ought to be considered for broader dissemination
among patients awaiting psychotherapy for depression.
Disseminating Deprexis: Evidence for the
transferability of an internet-based depression
programme across settings and regions
Björn Meyer1, Mario Weiss1, Steffen Moritz2, Warren Greig1
1
GAIA AG, Hamburg, Germany; 2University Medical Center
Hamburg-Eppendorf, Germany
Introduction: Meta-analyses have shown that internetbased self-help programmes for depression are effective,
but factors such as usage-intensity and the setting in
which the programmes are deployed might influence their
effectiveness.
Objectives and Methodology: This study aimed to
examine setting and usage intensity as predictors of
outcome among Deprexis users. Deprexis is an internetbased depression self-help programme that has been
shown to be effective in 3 randomized controlled trials.
We analysed data from 727 adults who had used the
programme in 6 different settings. For example, 37% had
used the Swedish programme version and had received
access from local psychiatrists. The remaining 63% had
used the German version and differed with regard to how
they accessed the programme (e.g., invitations from
insurance companies, online depression forums).
Results: A factorial ANOVA with two between-subjects
factors was conducted: (1) usage-intensity (tertiles: light,
medium, intense) and (2) setting (6 specific settings).
The dependent variable was the amount of depression
reduction between baseline and 9-weeks, measured
with the Patient Health Questionnaire (PHQ-9). Missing
data were substituted with last available observations
(ITT LOCF), as the PHQ-9 was administered in 3-week
intervals. Main effects were observed for usage intensity (p
< .01), consistent with a dose-response relationship, and
for setting (p < .01), such that the programme conferred
more benefit in settings with some initial screening or
support. The interaction was not significant.
Discussion and Conclusion: More is becoming known
about the factors influencing the effectiveness of online
depression self-help programmes. Initial screening
for motivation or fit, and encouragement of prolonged
engagement appear to be beneficial. The findings suggest
that internet depression-programmes can be disseminated
across settings and regions, and processes to optimize
their effectiveness can be delineated.
96
EABCT 2012
EABCT 2012
S38-01
Predicting Premature Termination within a
Randomized Controlled Trial for Binge-Eating
Patients
Christoph Flueckiger1; Andrea Meyer2; Bruce E.
Wampold3; Simone Munsch4
1
University of Zurich, Switzerland; 2University of Basel,
Switzerland; 3University of Wisconsin-Madison, Madison,
USA; 4University of Lausanne, Switzerland
Introduction: Understanding the dropout rates of
efficacious forms of psychotherapy for patients with
binge eating disorder (BED) is an unsolved problem
within this increasing population. Up until now the role
of psychotherapy process characteristics as predictors of
premature termination has not been investigated in the
BED literature.
Objectives: Within a randomized controlled trial (N = 78)
we investigated the degree to which early psychological
process characteristics such as components of the
therapeutic relationship and the experiences of mastery and
motivational clarification predicted premature termination
of treatment. Methodologies: Conducting binary logistic
regressions, we statistically controlled for the influences of
covariates such as rapid response of treatment, treatment
group, body mass index, Axis II disorder and patients’
preexisting generalized self-efficacy at baseline.
Results: Patients’ post session reports from sessions 1
to 5 indicated that low self-esteem in-session experiences
was a stable predictor of premature termination. Its
predictive value persisted after controlling for the above
mentioned covariates. Exploratory analyses further
revealed low self-esteem experiences, low global alliance,
low mastery and clarification experiences as predictors in
those patients, who explicitly specified discontentment
with therapy as reason for premature termination.
Discussion: These results indicate that patients’ selfesteem experiences may not be an epiphenomenon of
their specific psychopathology but may represent general
mechanisms on which remaining or withdrawing from
psychotherapeutic treatment depends. Early psychotherapy
process characteristics should therefore be considered
in training and evaluation of psychotherapists carrying
through BED treatments.
97
38
Internet-based guided self-help for anxiety
disorders: A randomized controlled trial
comparing an individually-tailored with a
primary disorder-specific approach
Thomas Berger1, Johanna Böttcher2, Franz Caspar1
1
University of Bern, Switzerland; 2University of Berlin,
Germany
Introduction: A growing body of evidence suggests
that Internet-based guided self-help treatments can lead
to significant improvements in a variety of conditions
including anxiety disorders. In this treatment format,
the presentation of a web-based self-help program is
combined with minimal but regular therapist contact via
email. Commonly, the web-based self-help program is
based on disorder-specific CBT manuals. However, the
self-help material can also be individualized to a patient’s
comorbid problems or disorders.
Objectives and Methodology: We have developed
Internet-based self-help modules for social anxiety
disorder, panic disorder with our without agoraphobia,
and generalized anxiety disorder, which can individually
be assigned according to a patient’s problems. In an
ongoing randomized controlled trial, we compare this
individually-tailored approach with a standardized primary
disorder-specific intervention in which participants only
get access to the modules that correspond to their primary
diagnosis. A total of 120 participants diagnosed with at
least one of the anxiety disorders mentioned above are
randomly assigned to one of the two treatment conditions
or to a wait-list control condition. Treatment lasts for 8
weeks, and is guided by therapists in training. Since not
all participants suffer from the same primary disorder,
disorder-unspecific measures such as the Beck Anxiety
Inventory and the Brief Symptom Inventory are used as
primary outcome measures. Secondary outcomes include
disorder-specific measures and data from a telephoneadministered diagnostic interview conducted at pre- and
posttreatment.
Results, Discussion and Conclusion: This is an
ongoing study which will be finished in April 2012. Final
results of this randomized controlled trial will be presented
and discussed.
Symposium 38 - Preconditions for
Therapeutic Change in CBT
Symposium
S37-04
S38-02
Symposium
38
Differences among Novice Therapists in Delivery
of CBT in Early Sessions
Jennifer Cheavens1; Daniel R. Strunk1
1
Ohio State University, USA
Introduction: In recent decades, there have been
numerous advances in the development and dissemination
of empirically-supported treatments (ESTs) for various
psychological disorders. As this research base expands,
many clinical training programs are focusing on ensuring
that trainees learn and can adequately deliver various ESTs.
There may be less focus, however, on ensuring that trainees
are able to deliver ESTs with appropriate levels of warmth,
responsiveness, and in-session collaboration. In a recent
treatment of depression trial, advanced graduate students
were trained to deliver cognitive-behavioral interventions.
Little attention, however, was given specifically to training
in the process of treatment delivery. Objectives: First,
we looked for a trainee effect in patient response over the
course of a 16-week intervention for depression. Second,
using observer-ratings of early therapy sessions, we tested
for differences in trainee behaviors to explain outcome
differences. Methodologies: Participants included 6
trainees and 42 patients with Major Depressive Disorder.
Depressive symptoms were assessed using both interview
(i.e., Hamilton Rating Scale for Depression) and self-report
(i.e., Beck Depression Inventory) measures. Two raters,
unaware of condition, outcome, and purpose of the rating
project, rated therapist warmth/expressiveness, therapist
responsiveness, collaboration, and facilitative conditions
(i.e., clinician’s efforts to provide a therapeutic environment)
in sessions 2 and 4 of a 16-week intervention.
Results: To address the first objective, we examined
differences in drop-out, response status, and the slope of
symptom change across the 16 weeks of treatment as a
function of trainee. Patients meeting with this trainee had
a significantly slower rate of change (d = -.55), were more
likely to prematurely drop-out of treatment, and tended to
have worse response rates than other patients. To address
the second objective, we compared the trainee of interest to
other trainees on in-session therapist behaviors. We found
that this same trainee was rated as less warm (d = 1.48),
responsive (d = -.89), and collaborative (d = -.83) than the
other trainees.
Discussion: One of the six trainees demonstrated
significantly different in-session behaviors than the other
trainees. Additionally, the patients who met with this trainee
had worse outcomes across a number of measures. These
results raise questions about the best ways to train students
in treatment delivery. Future research should examine how
to train students to deliver cognitive-behavioral treatments
with warmth, responsiveness, and in collaboration with
98
the patient. In order to ensure that ESTs are delivered with
maximum efficacy, it may be important to train novice
therapists in both specific intervention and delivery
techniques.
S38-03
The role of treatment expectations in the
treatment of depressed patients: Predicting
outcome and potential pathways
Tobias Krieger1; David Altenstein1; Nadja Doerig1; Martin
Grosse Holtforth1
1
University of Zurich, Switzerland
Introduction: In recent years, research has repeatedly
shown an effect of expectations on treatment outcome.
Some researchers have hypothesized that this association
is mediated by the patient-therapist alliance, but empirical
research is sparse. Furthermore, the associations between
expectations, the therapy relationship, and outcome might
help to explain the finding that individuals with recurrent
depression appear to be less responsive to therapy
regardless of specific treatment.
Objectives: First, we examined the relationship
between outcome expectations and treatment outcome.
Subsequently, we investigated the associations between
expectations, the therapy relationship, and outcome for
patients with recurrent and non-recurrent depression in
more detail.
Methodology: Within an ongoing RCT for depressive
patients comparing two variants of cognitive-behavioral
therapy (N = 86), we investigated the relationship between
recurrence of depression and therapy outcome with hope
of improvement and the therapeutic alliance as mediators.
Results: Pretreatment fear of change but not hope for
improvement predicted treatment outcome directly.
Investigating the recurrent nature of depression, mediation
models showed that the relationship between recurrence
of depression and therapy outcome was mediated by the
therapeutic alliance. Furthermore, the relationship between
recurrence of depression and the therapeutic alliance was
mediated by hope for improvement at pretreatment (but
not fear of change) independent of treatment modality and
depressive symptoms.
Discussion: Results indicate that a) the therapeutic
alliance and b) patient’s outcome expectations are important
factors for the prediction of treatment outcome especially
in patients suffering from recurrent depression. Depressed
patients who have positive outcome expectations may be
more likely to engage in a collaborative working alliance
with their therapist, which may, in turn, promote clinical
improvement.
EABCT 2012
EABCT 2012
S39-01
Processing of general emotional information
in social anxiety disorder – neural issues of
cognitive control and effect of a cognitive
behavioral
Annette Beatrix Brühl1, Michael Rufer1, Aba Delsignore1,
Lutz Jäncke2, Martin Grosse Holtforth2, Uwe Herwig1
1
University Hospital Zurich, Switzerland; 2University of
Zurich, Switzerland
Specific anxiety disorders are characterized by altered
emotion processing of phobia-specific stimuli at the
neurobiological level. Recent work has concentrated on
specific anxiety-provoking stimuli; focusing on arousal- or
fear-related brain areas such as the amygdala. However,
the neural correlates of the processing of emotional stimuli
without relation to the specific fears and of non-fear specific
emotion regulation have not been addressed before. We
found increased activation in brain regions involved in
emotional valence and arousal during the anticipation and
perception of general emotional stimuli pointing to biased
general emotion processing in social anxiety disorder
(SAD) compared to healthy subjects. When applying
cognitive control by reappraisal in SAD, we found regulatory
influences onto amygdala, insula and medial thalamus, but
no increase in regulating brain regions as medial prefrontal
cortex, which was typical in healthy subjects. This again
points to disturbances of general emotion processing and
regulating circuits in SAD. Current psychotherapy of specific
anxiety disorders primarily focuses on strengthening
emotion regulation when facing the specific feared stimuli,
for instance by changing the appraisal of evoking situations
and stimuli. A cognitive-behavioral group therapy in SAD
resulted in reductions in brain regions with increased
activity compared to healthy subjects when anticipating
and perceiving general emotional stimuli pointing to an
effect of specific psychotherapy also onto general emotion
processing brain circuits.
99
39
Sudden gains and sudden losses in terms of
process and symptom status
Torsten Ehrlich1; Wolfgang Lutz1
1
University of Trier, Germany
Introduction: In psychotherapy research, discontinuous
progress can be found in many patients. Sudden gains, i.e.
the tremendous decrease of symptom distress from one
session to the next, could be identified under conditions
of continuous assessment. Also in terms of process
satisfaction, both sudden gains and losses could be
defined from patients’ session reports. Sudden gains are
associated with good outcome and rather short therapies,
whereas sudden losses are associated with rather poor
outcome.
Objectives: Since sudden shifts occur most frequently
very early in treatment (around session 3), general factors
like therapeutic alliance and extra-therapeutic events are a
promising object of research of sudden gains and losses.
Methodology: 82 videotaped sessions of 53 patients in
symptom (HSCL) condition and 104 sessions of 60 patients
in the process (session reports) condition were coded
using the Rupture Resolution Rating System (EubanksCarter, Muran & Safran, 2009). External events preceding
the sudden shifts were coded from the videos and from
self-reports filled by the patients every 5 sessions.
Results: The frequency of both alliance ruptures and
rupture resolution between the session types differs
between the symptom and the process group. In the
symptom condition, neutral sessions are coined by many
ruptures and high resolution whereas sudden gains and
losses tend to have fewer rupture markers. In sudden
gain sessions, ruptures tend to be more confrontational
and there is more resolution than in sudden losses. Also,
patients report more negative external events in sudden
gain sessions than in other session types but also far more
positive ones. In the process condition, sudden gains have
very few rupture markers and therefore little resolution
whereas sudden losses have a high amount of rupture
markers with little resolution.
Discussion: The relevance of the results for the
understanding, the prediction and the dealing with certain
patterns of change in psychotherapy will be discussed.
Symposium 39 - Neurophysiological
correlates of change processes in
anxiety and depression
Symposium
S38-04
Symposium
39
S39-02
S39-03
How stress hormones modulate phobic fear
processing
Leila M. Soravia1; Melanie Fisler1; Andrea Federspiel1;
Helge Horn1; Thomas Dierks1; Wolfgang Schmitt1; Roland
Wiest1; Dominique J.-F. de Quervain2;
1
University of Bern, Switzerland, 2University of Basel,
Switzerland
Background: Previous experiments in patients
with phobia have shown that the administration of
glucocorticoids reduces fear in phobic situations.
Extensive evidence indicates that elevated glucocorticoid
levels inhibit memory retrieval processes. In patients with
phobia, exposure to a phobic stimulus provokes retrieval
of stimulus-associated fear memory that leads to the fear
response. It is therefore possible that glucocorticoids
reduce phobic fear through an inhibition of fear memory
retrieval. This is the first study investigating the acute
anxiolytic effect of cortisol administration in spider phobic
patients with fMRI when exposed to a phobic stimulus.
Method: In a double-blind, placebo-controlled study, 30
spider phobic patients receive either 20 mg hydrocortisone
or placebo 1 hour before the confrontation with a phobic
stimulus in the scanner. Psychological and physiological
measures are repeatedly assessed.
Results: Preliminary results show that the cortisol group
shows a greater amygdala activation (amygdala right:
t=2.983, p<.003; amygdala left: t=2.997, p<.003) in the
fast fear reaction but less amygdala activation (amygdala
right: t=-2.762, p<.006; amygdala left: t=-1.911, p<.058) in
the late fear reaction than the placebo group. Furthermore,
only the cortisol group shows a reduction of subjective
fear over the course of the experiment.
Conclusion: The analysis of the preliminary data show
that the administration of glucocorticoids enhance the
activation of the amygdala during the fast fear reaction
while it reduced the amygdala activation of the late fear
processing in the cortisol group compared to the placebo
group. The finding supports the view that glucocorticoids
reduce phobic fear through an inhibition of the retrieval of
fear memory in patients with phobia.
The implicit self - a possible biomarker of
depression
Yvonne Egenolf1; Maria Stein1,2; Thomas Koenig2; Martin
Grosse Holtforth3; Thomas Dierks2; Franz Caspar1
1
University of Bern, Switzerland; 2University Hospital
of Psychiatry, Bern, Switzerland; 3University of Zürich,
Switzerland
Aim: The dual process model of cognitive vulnerability
to depression (Beevers, 2005) assumes that depression
is manifested as a negative bias in implicit information
processing which is not sufficiently corrected by explicit
processes. However until today existing empirical
evidence provides limited support for this assumption. We
employed event related potentials (ERPs) to investigate the
existence of two distinct forms of information processing
assumed by the dual process model.
Methods: 25 healthy subjects performed of the selfrelevant Implicit Association Test (IAT) while brain activity
was measured with 70-channel EEG. Individual ERPs of the
implicit (congruent) and explicit (incongruent) condition
were used for group-analyses of differences in topography
(TANOVA) and amplitude (GFP). The neural generators of
the topographical differences were estimated by using the
LORETA inverse resolution method.
Results: The ERP analysis showed significant
topographical differences in the late ERP, which were driven
by higher activation in the anterior cingulated cortex, the
subgenual cingulated gyrus and the middle frontal gyrus
during the incongruent condition.
Discussion: The processing of incongruent information
is associated with additional activation of brain regions
that were implicated in conflict monitoring and cognitive
control. This might reflect the neural basis of explicit
processes, which over-rule the response tendency that is
more consistent with the implicit self-evaluation. Thus,
EEG activations correlating with implicit self-evaluation
might serve as a neural biomarker for depression.
100
EABCT 2012
EABCT 2012
S40-01
A Mobile Phone Intervention for Improving
Wellness – User Experience Study Results
Aino Ahtinen1; Pasi Välkkynen1; Tero Myllymäki2; Essi
Sairanen2
1
VTT Technical Research Centre of Finland; 2University of
Jyväskylä, Finland
Introduction: Oiva is a personal mobile phone intervention
based on Acceptance and Commitment Therapy (ACT).
The application aims at improving psychological flexibility
- and thus personal mental and physical wellness - with
the help of guidance and exercises in the audio, video and
textual formats. Before conducting large-scale effectiveness
studies, the user experiences and feasibility of a new
application must be studied to ensure its maturity. Positive
user experiences and flawless technical functionality are
required before a technology-based intervention can be
effective.
Objectives: We present the methodology and results
of a field study that focused on the user experiences (i.e.
usefulness, acceptance, perceptions, and usability), usage
activity, and feasibility of the Oiva application.
Methodology: 15 participants are recruited among the
local university employees and students for the field
study of one month. The participants are screened with
the Acceptance & Action Questionnaire (AAQ). The study
consists of an initial group meeting where ACT principles
and the application are briefly introduced to the participants.
The participants are given an Android mobile phone with the
Oiva application installed. The participants are advised to
use the application for one month. The user experiences are
studied with two questionnaires during the usage period and
a semi-structured face-to-face interview at the end. Log files
are captured from the mobile phones to study actual usage.
Results: In this presentation, the user experience and
usage results obtained in the study are presented. We also
describe how the results affected the further design of Oiva.
Discussion: The results of the study will be used to
verify the maturity of Oiva application for a large-scale
effectiveness study, where it will be compared to a face-toface ACT-based intervention. The findings of the study will
also be used to improve and finalize the application.
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40
Neurophysiological correlates of motivational
incongruence: An exploratory study
Maria Stein1,2; Yvonne Egenolf1; Franz Caspar1; Thomas
Dierks2; Thomas Koenig2
1
University of Bern, Switzerland; 2University Hospital of
Psychiatry, Bern, Switzerland
The construct of motivational incongruence is defined
by insufficient realization of a person’s motivational
goals. If these motivational goals imply the presence of
desirable experiences, dissatisfaction leads to approach
incongruence, if the goals imply the avoidance of aversive
experience, dissatisfaction leads to avoidance incongruence.
Motivational incongruence can be validly assessed with
the incongruence questionnaire and has been shown to
correlate with other clinically important parameters, as for
example subjective well-being and psychopathological
symptoms (Grosse Holtforth & Grawe, 2003). It is thus
well conceivable that such a construct, tightly related to
psychological functioning, should be reflected in the tonic
activity of the brain systems, as it can be assessed with
resting state electroencephalography (EEG). The studies
presented here therefore for the first time investigate a
potential correlation between motivational incongruence
and tonic brain activity: Healthy subjects (study 1) as well as
inpatients with anxiety and/or depressive problems (study
2) completed the INC-questionnaires and the subjects’
resting brain activity was measured with 70-channel EEG.
After preprocessing, correlations of the INC data with the
topographic distribution of EEG frequency bands as well
as with the Global Field Synchronization were investigated
and LORETA Source analyses were computed for significant
correlations. Our findings show, that a neurophysiological
signature of motivational approach incongruence can be
observed even in a healthy sample with only limited variance
of INK-values, and that this signature can be reproduced and
extended in a sample including patients with higher levels
of motivational incongruence. Furthermore our results
indicate that the Alpha-Frequency band is most sensitive to
increasing levels of motivational incongruence.
Symposium 40 - Internet- and web-based
Acceptance and Commitment Therapy
(ACT) applications: Experiences and
effect
Symposium
S39-04
Symposium
40
S40-02
S40-03
Oiva: A Mobile Phone Intervention for Improving
Psychological Flexibility
Elina Mattila1; Kirsikka Kaipainen1; Toni Vanhala1; Miikka
Ermes1; Raimo Lappalainen2
1
VTT Technical Research Centre of Finland; 2University of
Jyväskylä, Finland
Introduction: The increasing prevalence of stress and related
mental disorders calls for novel methods for the prevention and
self-management of these problems. Computerized therapies
have been proven effective in the management of various
mental and physical disorders. Mobile technologies hold
further promise as they enable interventions to be delivered
and accessed during the daily life of the user. For example,
user’s activities and context can be detected from sensor data
in order to infer opportune moments for influencing the user.
Objectives: Our objective is to develop a personalized and
context-sensitive mobile intervention application based on
Acceptance and Commitment Therapy (ACT) for increasing
psychological flexibility and improving mental and physical
wellbeing.
Methodology: Oiva is a mobile application that can be
used for conducting brief self-directed ACT-based exercises
with audio, video, or textual guidance. Oiva consists of four
intervention modules. Three of the modules are aimed at
teaching the user the six core processes of ACT (acceptance,
cognitive defusion, being present, self-as-context, values, and
committed action). The fourth module is related to physical
wellbeing, including relaxation, physical activity, and mindful
eating. A prototype of Oiva application was tested in two
laboratory evaluations.
Results: The evaluations provided valuable insights for
the development of Oiva. The comments of the participants
proved the concept understandable, acceptable and useful.
The potential of brief interventions delivered at opportune
moments was evident.
Discussion: Mobile applications provide a potentially
powerful delivery channel for psychological interventions.
Their effectiveness may be further increased by tailoring
intervention processes and content to individual’s
characteristics, needs, preferences, and progress. The
sensors embedded in the mobile phone enable detection of
users’ activities and contexts, such as location and social
situations. Context information can be utilized for providing
interventions at opportune moments, i.e. when interventions
are needed and accepted.
ACT for Depression online or face-to-face: The
Impact of an Internet-based treatment program
Päivi Lappalainen1; Anna Granlund1; Raimo Lappalainen1
1
University of Jyväskylä, Finland
102
Introduction: Improving access to psychological
treatments for common mental disorders such as
accessible regardless of time and place and enable the
patient working at his/her own time and pace depression
is regarded as a priority in several countries worldwide.
Interned delivered treatments offer a partially solution to
this and several other advantages as well: they are.
Objectives and Methodology: We developed a 6week web-based Acceptance and Commitment Therapy
(ACT) program for depression. The program included
two face-to-face sessions and weekly contact via internet.
The impact of the program was compared to a 6-week
individualized face-to-face treatment, also based on ACT.
The intervention was provided by psychology students
(n=18). Outpatients reporting mild depression symptoms
(n=38) were randomized to either approach, with each
student treating one client within each approach, linked to
a functional case formulation model.
Results: Clients treated within an Internet based treatment
model showed equal symptom improvement than the faceto-face clients (e.g. BDI-II change scores from Pre to F-up
for internet group 12.05 and for the face-to-face group
9.55). However, there was a trend for better maintenance
effect at 6 months’ follow-up in the internet-group.
Discussion and Conclusion: Internet-delivered ACT
with a few face-to-face sessions is possibly an alternative
for self-referred mild-to-moderate depression clients.
EABCT 2012
EABCT 2012
Symposium 41 - Integrating Metacognition
in Treatment of Psychopathology
Is the development of a Meta-cognitive Child
Therapy for children with GAD plausible?
Sara Kerstine Nielsen1; Barbara H. Esbjørn1; Jon Maaløv
Holm1; Maja Tyle1; Nicoline Normann1; Ingrid Leth1
1
University of Copenhagen, Denmark
Introduction: Metacognitive Therapy developed by
Prof. Wells and colleagues has proven promising in the
treatment of adult anxiety disorders, e.g. generalized anxiety
disorder (GAD). Furthermore, research into the theoretical
framework underlying metacognitive therapy has begun
to emerge also in adolescent and child samples. Partial
support has been found for the relation between positive
and negative meta-cognitions and elevated levels of worry
in both clinical and non-clinical samples of young people.
Although further research is needed before firm conclusions
regarding the role of meta-cognitions in clinically anxious
youth can be drawn, experiences from research integrating
the meta-cognitive approach into childhood treatments may
also provide valuable information.
Method: A group of 4 children aged 10-12 years diagnosed
with GAD as their primary anxiety disorder and their parents
were included in the pilot project. Treatment was based
on a pilot manual and delivered via 2 parent educational
evenings, 10 group sessions, and 2 family sessions. The
meta-cognitive model for GAD was presented to both
parents and children. Furthermore the parent evenings
contained psychoeducation and discussions on anxiety
maintaining mechanisms in the family. The group sessions
for the children contained identification of emotions,
thoughts, and actions to increase the children’s awareness
and understanding of their difficulties. The meta-cognitive
components integrated into the children’s group treatment
were psychoeducation on cognitions, meta-cognitions,
and the role of appraisal, attention training, detached
mindfulness, as well as identification and challenging of
meta-cognitions. Exposure to anxiety- and worry provoking
cues and situations were part of the sessions to increase
the likelihood of correct application of the meta-cognitive
therapy techniques. Special care was taken to restore control
over attention and appraisal, keeping a detached stance to
negative emotional arousal, and changing unhelpful metacognitions.
Results and conclusion: Difficulties relating to the
integration of meta-cognitive components into childhood
treatments and preliminary results will be discussed.
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41
S41-01
Symposium
S40-04 An ACT-based Internet Intervention
designed for University Students
Päivi Lappalainen1; Panajiota Räsänen1; Raimo
Lappalainen1
1
University of Jyväskylä, Finland
Introduction: University students report experiencing
psychological problems, for example, depression and
anxiety. Limited access to student counseling services and
the stigma associated with seeking help inside the campus,
are some of the reasons that may limit significantly the
possibility to receive psychological intervention. Self-help
therapies are proven to be effective in reducing mental
health problems. An Internet-based self-help intervention
could be an easily accessible, cost-effective alternative for
students.
Objective and Methodology: We developed an internetbased Acceptance and Commitment Therapy (ACT) selfhelp program to enhance general wellbeing and health
of university students. The aim was to investigate effects
and experiences of the program, and develop a model
that is suitable for a university context. The program was
designed with different types of comorbid problems, such
as depression, anxiety and school-related stress. The
program consisted of a six-week ACT-based intervention
with minimal therapist contact. In addition to an initial faceto-face assessment session, participants received weekly
support and written feedback on completed exercises.
Results: A preliminary pilot study (n=18) was conducted
during spring 2012. Examples of cases and students’
experiences of using the program are provided.
Discussion and Conclusion: We will discuss our
experiences and our preliminary ideas of the possible
applications of the program.
S41-02
Symposium
41
Effectiveness of individual and group
metacognitive therapy for generalized anxiety
disorder: A benchmarking approach
Colin van der Heiden1
1
Erasmus University Rotterdam, The Netherlands
Introduction: Metacognitive therapy (MCT) for GAD has
been developed in an attempt to augment the efficacy of
CBT for GAD, as reviews of the clinical significance has
indicated that only about 50% of patients with GAD return
to a ‘well’ status following treatment. Preliminary evidence
indicates that MCT is an efficacious treatment for GAD
(Wells & King, 2006; Wells et al., 2010).
Method: Randomized clinical trial into the effectiveness
of individual MCT (Van der Heiden et al., 2012) and an
open trial into the effectiveness of group MCT (Van der
Heiden et al., submitted). Results of these studies will be
presented, and both approached will be compared using a
benchmarking strategy.
Results: Both individually delivered and group MCT
produce significant pre to posttreatment decreases in GAD
symptoms, with large effect sizes and high proportions
of clinically significant change. At follow-up, the
improvements are maintained. However, the magnitude
of change and the degree of clinical significance of group
MCT are smaller than those reported for individually
delivered MCT for GAD. Further, the attrition rate (48%)
suggests that group MCT is only moderately acceptable to
patients with GAD.
Discussion: The results of both studies suggest that
MCT is an effective treatment for GAD. This is especially
true for individually delivered MCT, which produces better
results and is more acceptable to patients than group MCT.
Conclusion: Individually delivered MCT should be
preferred over group MCT in the treatment of GAD.
S41-03
Metacognition and caregiver distress in first
episode psychosis: Implications for CBT based
family work. Preliminary results
Jens Einar Jansen1; Ulrik H.Haahr1; Susanne Harder1; H.G.
Lyse1; M.B. Pedersen1; U. Søgaard1; A.M. Trauelsen1; E.
Simonsen1
1
University of Copenhagen, Denmark
Introduction: The evidence supporting family work in
psychosis is firmly established. However, there is less
data on first episode psychosis, and the understanding
of caregiver distress is limited. The authors investigate
the hypothesis that level of metacognition is an important
104
factor in caregivers’ experience of distress and burden.
This is of significance, as caregiver distress is related
to higher levels of expressed emotion, which has been
related to higher rates of relapse. Method: Interviews with
120 patients and two of their closest relatives. Preliminary
results rest on 20 subjects. Metacognition is measured
using a modified version of Metacognitive Assessment
Scale (Lysaker et al., 2005). Expressed emotion is assessed
by Family Questionnaire (Wiedemann et al., 2002),
and caregiver distress is measured by General Health
Questionnaire (Goldberg, 1972). Subjective appraisal
of caregiving is assessed by Experience of caregiving
Inventory (Szmukler et al., 1996).Results: Pearson
correlations show association between expressed emotion
(emotional overinvolvement) and levels of metacognition
(0.578, P<.05) and between positive appraisal of being
a caregiver and level of metacognition (0.513, P<.05).
There are also significant correlations between negative
appraisals of being a caregiver and distress (0.617,
P<.001), and between emotional overinvolvement and
distress (0.654, P<.001).
Conclusions: The preliminary results give some support
to the theory that level of metacognition is relevant to
caregivers´ experience of burden and distress, and for the
emotional climate in the family. This may contribute to a
better understanding of expressed emotion and caregiver
distress, and may have important implications for tailoring
family interventions to the needs of the family.
S41-04
Metacognition and schizophrenia: An
investigation of metacognitive beliefs and
psychopathology within the OPUS cohort at 10
year follow up
Stephen Austin1; Ole Mors1; Morså, L. 1; Roger Hagen2;
Gry Secher3; Merete Nordentoft3
1
Århus University Hospital, Risskov, Denmark;
2
Norwegian University of Science & Technology,
Trondhaim, Norway; 3Psychiatric Centre Copenhagen,
Denmark
Metacognition is concerned with the thinking about
thinking and regulation of cognition. The Self-Regulatory
Executive Function (S-REF) model hypothesizes that certain
metacognitive beliefs become maladaptive when they
are excessively utilized, leading to the development and
maintenance of psychopathology. Previous studies have
found an association between maladaptive metacognitive
beliefs and the predisposition and/or exhibition of positive
psychotic symptoms. These metacognitive beliefs may lie on
a continuum, where severity of metacognitive beliefs, may be
linked to different phases in the development and maintenance
of psychotic symptoms- the continuum hypothesis
EABCT 2012
S41-05
Towards a metacognitive framework on anger:
Introducing the Metacognitive Beliefs and Anger
Processing (MAP) scale
Stine Bjerrum Moeller1
1
Mental Health Centre North of Zealand, Denmark
Introduction: With its association with aggression and
violence, dysregulated anger deserves priority as a target
for clinical intervention. Recently, clinical psychology has
focused on common features of information processing
across disorders. One approach is the metacognitive
model (Wells & Matthews, 1994; Wells, 2000). However,
few studies have explored the metacognitive components
of anger, and at present, there is no coherent metacognitive
framework on anger.
The goal of the present studies was to apply a metacognitive
framework to anger by developing a new self-report anger
scale. This new scale, the Metacognitive Beliefs and Anger
Processing (MAP) scale, was developed with an eye
toward clinical utility.
Method: Pre-tested with non-clinical and prisoners
EABCT 2012
105
41
samples the MAP demonstrated three empirically distinct
dimensions of metacognition: positive beliefs (“anger
helps me handle threats and danger”); negative beliefs
(“anger could make me go mad”); and rumination (”I
cannot let go of angry thoughts”). The present two studies
concerned a clinical sample (N = 88) and a forensic sample
(N = 54).
Results: The reliability the MAP subscales were
satisfactory. Using CFA, the factor structure obtained in
earlier studies was confirmed. Regarding the convergent
validity of the rumination subscale, several tests were
conducted, substantiating its validity. Positive as well
as negative beliefs were associated with rumination
about anger events, which is consistent with the generic
metacognitive model. In the clinical sample, a hierarchical
regression showed that the MAP subscales were stronger
predictors of anger (NAS) than was the MCQ-30 Total.
Conclusion: In agreement with the general metacognitive
measure, themes of uncontrollability, danger, and madness
are involved in anger dysregulation. Self-perpetuating
cycles of processing negative stimuli can occur in relation
to anger, and rumination may not only maintain emotional
distress but also maintain elevated bodily arousal. Clinical
implications for using the MAP as a metacognitive measure
with specific relevance to anger, is discussed.
Symposium
Objective: To examine the association between levels
of metacognitive beliefs and different courses of illness
within a cohort of schizophrenia spectrum disorders.
Method: The sample consisted of 547 people with first
episode psychosis recruited as part of the OPUS trial
(1998-2000). The study design was cross-sectional,
information about course of illness and positive symptoms
was collected using Lifechart Schedule and Schedule for
Positive Symptoms (SAPS) whilst current metacognitive
beliefs were assessed using the Metacognitions
Questionnaire (MCQ-30).
Results: A total of 347 participants were interviewed at 10
year follow-up. There was a significant correlation between
delusions and hallucinations and all types of maladaptive
metacognitive beliefs. Levels of maladaptive metacognitive
beliefs varied as a function of course of illness, with the
highest levels of maladaptive metacognitive beliefs were
associated with the most severe course of illness. There
was no significant difference in levels of maladaptive
metacognitive beliefs between the non-psychotic course of
illness and the control condition. The regression analysis
was significant (F (7, 322) 6.17 p<0.001), which showed
course of illness accounted for between 14-21% of the
variance displayed in maladaptive metacognitive beliefs.
Conclusion: There was significant relationship between
course of illness and levels of maladaptive metacognitive
beliefs within schizophrenia spectrum disorders. Clinical
interventions that can modify maladaptive metacognitive
beliefs could potentially impact on course of illness in
schizophrenia.
Symposium 42 - Attentional processes in
anxiety: basic to applied applications
S42-01
Symposium
42
Attentional training for anxiety: Impact of
Instructional and Stimulus Contingency
Jonathan Huppert1; Thomas L. Rodebaugh2
1
The Hebrew University of Jerusalem, Israel; 2Washington
University, USA
Individuals with SAD have cognitive biases including
attentional allocation to threatening stimuli (e.g.,angry
faces) and difficulty in disengaging from such stimuli.
Recent data suggest that that computerized attentional
training away from threat may reduce social anxiety
symptoms. However, many parameters may influence the
results of such training. Two important parameters are
instructions: whether individuals are instructed to use
the stimuli in the paradigm in a particular fashion and
contingencies: the actual contingencies of how often the
dot probe follows a particular stimulus type. We will present
data examining the impact of instructed, contingencybased, and their combination on training attentional biases
and social anxiety. We designed a modified 3 (instructions:
avoid, none, attend) by 3 (contingencies: avoid, none,
attend) design (without conflicting conditions) to
determine the impact of instructions and contingencies on
shaping biases and vulnerability to anxiety. 140 moderately
anxious participants (20 per condition; to date, 105
have completed) will be randomized to one of 7 training
conditions and then evaluated in terms of cognitive biases
and anxiety vulnerability. We hypothesize that combined
training away from threat will have the greatest impact
on both early and later cognitive biases and on anxiety
vulnerability/ reactivity. Results from this study builds
on the cognitive bias modification literature and may
have significant implications for cognitive models of the
maintenance and treatment of anxiety.
S42-02
Windows to social anxiety: Temporal unfolding of
attention to the eyes
Eva Gilboa-Schechtman1; Yair Shahar1; Ronny Geva1
1
Bar Ilan University, Israel
Introduction: Face perception is a basic process in
interpersonal communication. The eyes contain critical
information for assessing interest, emotion, and threat.
The amount of eye contact affects the ability to interpret
intentions and meanings of social situations. Compared
106
to low socially anxious (SA) individuals, high SAs are
found to make less eye contact during social interactions
and to show less gaze fixations on the eyes when viewing
emotional facial expressions (EFEs).
Objective and Methodology: We examined vigilance,
disengagement, and avoidance in processing EFEs. Eye
movements of high SAs (n=18) and low SAs (n=18) were
recorded by a Tobii 1750 eye tracker, while they viewed30
EFEs exhibiting angry, disgust, happy, sad, neutral
emotions.
Results: HSAs allocated attention to the eyes earlier, and
fixated on eyes longer than did LSAs. Moreover, HSAs
exhibited longer first-to-second fixation duration on eyes
as compared to LSAs. The pattern longer fixations and
longer avoidance was especially pronounced with EFEs
expressing social disapproval.
Discussion and Conclusions: HSAs appear to exhibit
impaired executive control while viewing EFEs, especially
those carrying potential for social disapproval.Eye contact
is the first juncture that high SAs stumble upon in everyday
interactions. Understanding – and possibly modifying –
this process may affect social performance in SA
S42-03
Attention Capture by Salient, but Neutral, Stimuli
in Anxiety
Jason Moser1; Tim P Moran1; Mark W Becker1
1
Michigan State University, USA
Introduction: Substantial work has been conducted on
the tendency of anxious individuals to direct attention
to emotional stimuli. Less, however, has been dedicated
to understanding attention allocation to neutral, nonemotional, stimuli in anxious individuals that may
illuminate attention biases toward instances of motivational
salience more generally.
Objectives & Methodology: To address this gap,
we examined the association between trait anxiety and
attention capture by a task-irrelevant color singleton (i.e.,
distractor) in a visual search task. In Study 1, distractor
cost was measured as the difference in reaction time (RT)
between distractor present and distractor absent trials.
In Study 2, RT distractor cost was measured along with
a neural (i.e., event related potential, ERP) measure of
distractor cost. State anxiety was also manipulated in
Study 2.
Results: Across studies, we found that trait anxiety was
associated with larger RT distractor cost, indicating greater
distraction by the irrelevant color singleton in high trait
anxious individuals. Findings from Study 2 also revealed
a relationship between trait anxiety and enhanced ERP
distractor cost in the N2pc component, which indexes
suppression of irrelevant information. Neither of these
EABCT 2012
The role of emotional information processing in
recovery from anxiety
Andrea Reinecke1; Lara Waldenmaier1; Myra J Cooper1;
Catherine J Harmer1
1
University of Oxford, United Kingdom
Introduction: Cognitive behavioural therapy (CBT)
is a psychological treatment that effectively resolves
emotional disorders such as anxiety or depression, but
the mechanisms underlying successful intervention are
far from understood. While it has been a long-held view
that psychopharmacological approaches work by directly
targeting automatic emotional information processing in the
brain, it is usually postulated that psychological treatments
affect these parameters only over time, through changes in
more conscious thought cycles.
Objectives and Methodology: As a paradigm target, we
examined samples with panic disorder (N=28). We measured
immediate effects of a single session of CBT on automatic
threat processing and monitored anxiety symptoms over the
following four weeks.
Results: We found that vigilance for threat information
was reduced the day after treatment and before subjective
reductions in symptoms. The magnitude of this early effect
on threat vigilance predicted therapeutic response after 4
weeks.
Discussion and Conclusion: Our results indicate that the
mechanisms of action of pharmacological and psychological
treatment are more similar than previously assumed. The
findings provide mechanistic insight into a key action of
CBT for anxiety disorders and suggest how novel, more
effective pharmaco-psychological combination treatments
could be developed by the application of neuroscience.
EABCT 2012
A randomized controlled trial on Internetdelivered treatment for social anxiety disorder attention bias modification training vs. cognitive
behavior therapy
Per Carlbring1
1
Umeå University, Sweden
Both computerized cognitive bias modification (CBM) and
internet-based cognitive behaviour therapy (iCBT) have in
several well conducted trials shown great promise in the
treatment of social anxiety disorder. However, their relative
efficacy is yet unknown. After a diagnostic interview 79
participants, meeting DSM-IV criteria for social phobia,
were randomized to either CBM or iCBT. In the CBM
condition the participant was trained to direct attention
away from threat using a probe detection task, whereas in
iCBT the treatment included the standard components of
psychoeducation, cognitive restructuring and exposure.
In addition to the web-based self-help material in the
iCBT condition 15 minutes of weekly e-mail support
was included during the 9 treatment weeks. The outcome
measures were Liebowitz Social Anxiety Scale, Social
Phobia Screening Questionnaire, Social Phobia Scale,
Social Interaction Anxiety Scale, Becks Anxiety Inventory
(BAI), Montgomery Åsberg Depression Rating Scale and
the Quality of Life. Results were analyzed on an intentionto-treat basis, including all randomized participants. At
the time of the conference 6-month follow-up data will be
available and presented, including a blinded diagnostic
re-interview. The immediate results point in the direction
that both treatments rendered significant time effects
with large within group effect sizes. However, on one of
the secondary outcome measures (BAI) a significant
interaction was identified in the direction of superiority of
the iCBT condition.
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42
S42-04
S42-05
Symposium
effects were moderated by state anxiety. We will also
present preliminary data from an attention modification
protocol in which trait anxious participants will be trained
to focus on targets and away from distractors as a means
of intervention.
Discussion & Conclusion: Collectively, these findings
suggest that anxiety is associated with a general
enhancement of bottom-up processes involved in
motivational significance detection, which may represent
a trait marker. Moreover, this bias may manifest as a result
of inefficient inhibition of salient, irrelevant information.
Implications for the role of this basic attention bias in
emotional processing and treatment will be considered.
Symposium 43 - Understanding and
treating psychiatric sequelae following
exposure to mass violence
S43-01
Symposium
43
Efficacy of a therapist-assisted internet-based
writing therapy for traumatized child survivors
of the 2nd World War with Posttraumatic Stress
Disorder
Maria Böttche1; Philipp Kuwert1; Christine Knaevelsrud1
1
Treatment Center for Torture Victims, Berlin, Germany
Introduction : Epidemiological studies indicate that
Posttraumatic Stress Disorder (PTSD) is a common
condition in older adults. Nevertheless, only a few studies
have evaluated the efficacy of existing therapies and agespecific treatment approaches. The aim of this study was
to evaluate an internet-based cognitive-behavioral writing
therapy (Integrative Testimonial Therapy, ITT), developed
for the treatment of older PTSD patients traumatized in
their childhood.
Objectives and Methodology: In a randomized
controlled trial, eighty-eight older adults with warassociated (subsyndromal) PTSD were assigned to a
treatment or waiting list group (ITT: n = 43, M = 74.4 years,
waiting list: n = 45, M = 71.8 years). Primary outcome
was PTSD symptom severity. Secondary outcomes were
depression, anxiety, and resource-oriented variables. Data
were collected at five assessment points (pre, post, three-,
six- and twelve-months follow-up).
Results: Intent-to-treat analysis revealed a significant
decrease of PTSD symptom severity and a significant
increase of quality of life and self-efficacy in the treatment
group compared to waiting list (group x time interaction:
PTSD: F(1,86) = 8.36, p = .005; quality of life: F(1,86) =
10.78, p = .001; self-efficacy, F(1, 85) = 7.35, p = .008).
These changes maintained stable at 12-month follow-up.
Discussion and Conclusion: This newly developed
approach was highly accepted and resulted in significant
and stable improvements in PTSD and general
psychopathology in older adults traumatized 65 years ago.
108
S43-02
Traumatic experiences and transgenerational effects
in Kosovarian children and their traumatized parents
Naser Morina1; Richard Klaghofer1; Julia Müller1; Matthis
Schick1
1
University Hospital Zurich, Switzerland
Introduction: Literature shows that parental trauma and
psychopathology affects not only the mental health of
their children but also their school performance and social
behavior, aggression and quality of life. The aim of this
study was to examine the mental health of children living
in a post-war zone and to assess the relationship between
parents’ traumatic experiences and children’s mental health.
Methodology: The study was conducted in Kosovo
eleven years after the war. The randomly selected sample
included 51 families (both parents and one child aged 1117), all of them were living during the war and afterwards
in Kosovo. Both parents and children completed structured
interviews and questionnaires regarding their mental
health, traumatic event types and trauma disorders.
Results: Preliminary results show that exposure to war
trauma impacts on both parents’ and children’s mental
health, whose emotional responses are inter-related.
Particularly mothers’ well-being and fathers’ trauma
severity seems to have the largest impact.
Discussion: Our findings support the notion that child
mental health in vulnerable family situations is associated
with both maternal and paternal mental health outcomes
even more than a decade after the war. Specific support for
children and their traumatized parents is necessary.
S43-03
Anger regulation in traumatized Cambodian
refugees: Buddhist perspectives
Angela Nickerson1; Devon E. Hinton2
1
University of New South Wales, Sydney, Australia;
2
Massachusetts General Hospital and Harvard Medical
School, Boston, USA
Introduction: Recent research has highlighted the
importance of traditional healing in relation to the treatment
of psychological distress in non-Western populations. While
anger is commonly observed in traumatized populations,
there are few treatment strategies that specifically target
anger reactions following exposure to mass trauma.
Objectives: This study, conducted in Lowell
Massachusetts, investigated what Buddhist Cambodian
monks consider to be the causes and phenomenology of
anger among Cambodian refugees and what they suggest
to be appropriate intervention strategies.
EABCT 2012
Comorbidity of Major Depression and PostTraumatic Stress Disorder in a large community
sample of survivors of war
Nexhmedin Morina1; Stefan Priebe2
1
University of Amsterdam, The Netherlands; 2University of
London, United Kingdom
Introduction: Major Depressive Disorder (MDD) and
post-traumatic stress disorder (PTSD) are the two most
common mental disorders following exposure to traumatic
experiences and often co-occur.
Objective: This study aimed at examining patterns of
comorbid MDD and PTSD in relation to etiological factors
and clinical characteristics.
Methodology: Using face to face interviews, 3.313 survivors
of war in five Balkan countries participated in the study.
Results: Twelve percent of participants met criteria for both
disorders. About three-quarter of participants with MDE
or PTSD met criteria for a co-occurring mental disorder.
Compared to PTSD only, comorbid PTSD and MDE was
associated with higher numbers of pre-war and post-war
traumatic events. Compared to MDE only, comorbid PTSD
and MDE was associated with higher number of warrelated events. Finally, participants with co-occurring MDE
and PTSD reported higher levels of general psychological
symptoms and suicidality and lower levels of quality of life
than participants with either condition alone.
Discussion: The results indicated that comorbid MDD
and PTSD may be regarded as a relevant distinct category.
People with this co-occurrence may require specific health
care programs following war.
EABCT 2012
S44-01
The COBALT trial: background and protocol
Anna Abel1; Nicki Ridgway2; Samantha Green3
1
University of Exeter, United Kingdom; 2University of
Glasgow, United Kingdom; 3University of Bristol, United
Kingdom
Introduction: Only around 1/3 of patients with depression
respond fully to antidepressant medication.
Objectives: The COBALT study is a HTA-funded multi-centre
(Bristol, Exeter and Glasgow) pragmatic RCT of CBT given as
an adjunct to pharmacotherapy for primary care patients with
treatment resistant depression (those who have significant
depressive symptoms following at least 6 weeks treatment
with antidepressant medication at an adequate dose). The
aim is to determine the effectiveness of CBT (in addition to
pharmacotherapy) over the following 12 months (compared to
usual care alone) and (ii) to determine the cost-effectiveness
of this intervention.
Entry Criteria: Eligible patients were: (i) aged 18-75 years;
(ii) currently taking antidepressant medication (for ≥6
weeks at an adequate dose); (iii)scoring ≥ 14 on the BDIII; (iv) who had adhered to their medication; and (v) who
met ICD-10 criteria for depression. The primary outcome
was depressive symptoms assessed using the BDI-II at
6 months post-randomisation. Secondary outcomes at 6
and 12 months included quality of life, antidepressant use
and health care utilisation.
S44-02
Clinical effectiveness of CBT as an adjunct
to pharmacotherapy for treatment resistant
depression in primary care
Nicola Ridgway1
1
University of Glasgow, United Kingdom
469 patients were randomised to either continue with
usual care (including antidepressants) or to receive 12-18
sessions of CBT in addition to usual care. 90% (n = 422)
of participants were followed up at 6-months (primary
outcome) and 84% (n = 396) at 12-months.
95 participants (46.1%) in the intervention group met
criteria for ‘response’ (≥50% reduction in depressive
symptoms compared to baseline) at 6 months compared
to 46 participants (21.6%) in the usual care group (odds
ratio (OR): 3.26 (95%CI: 2.10, 5.06) p<0.001). Those
randomised to the intervention group were more likely
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Symposium 44 - CBT for treatment
resistant depression: results from the
COBALT trial
Symposium
Methodology: Six monks were interviewed at four major
temples in Massachusetts. Semi-structured interviews
were conducted to examine the frequency, triggers, and
expression of anger, as well as suggested interventions.
Grounded theory was implemented to extract key themes
from the interview transcripts.
Results: Findings suggested that anger was common
in the Cambodian community, was frequently triggered
by marital discord, and commonly resulted in verbal and
physical violence, and sometimes, suicidality. Buddhistbased anger management strategies identified as useful by
the monks included education about Buddhist doctrines,
mindfulness meditation practices, and the use of herbal
medication and holy water.
Discussion: These anger regulation strategies and
treatments are discussed in the context of Buddhist beliefs
and western psychological interventions.
Conclusion: Traditional healing represents an important
avenue for investigation for the development of culturallyappropriate interventions for anger in traumatized groups.
to experience ‘remission’ (BDI score<10) at 6 months
(OR: 2.30 (95%CI: 1.39, 3.81) p=0.001). In repeated
measures analyses using data from 6 and 12 months, the
corresponding ORs for ‘response’ and ‘remission’ were:
2.89 (2.03, 4.10) p <0.001 and 2.74 (1.82, 4.13) p<0.001.
Conclusion: Amongst patients who have not responded
to antidepressants, CBT when given in addition to
pharmacotherapy is effective in reducing depressive
symptoms and these effects are maintained over 12
months. It will be important to evaluate the effectiveness
of this intervention over the long-term.
S44-03
Symposium
44
Cost-effectiveness of CBT as an adjunct to
pharmacotherapy for treatment resistant
depression in primary care: economic evaluation
of the COBALT trial
Chris Williams1
1
University of Glasgow, United Kingdom
We report the cost-effectiveness of the COBALT
intervention compared with usual care. This was carried
out from the perspectives of: (i) the health and social care
providers (the National Health Service) and personal social
services (PSS); (ii) participants; and (iii) wider society.
Two types of analysis are presented: a cost-consequences
framework compares cost from each perspective with a
range of primary and secondary outcomes and a costutility analysis is used to compare NHS and PSS costs
with quality adjusted life years (QALYs). Both analyses are
based on the costs incurred and the benefits obtained over
the 12 months following randomisation into each group.
The cost was estimated using data on the number of CBT
sessions received by each participant, the length of the
sessions and the grade of the staff member. An additional
cost was included to allow for supervision, and did not
attend sessions were costed at 50% of the full rate. Other
NHS and PSS costs include primary care appointments
by health care profession and location; prescribed
medication; hospital outpatient appointments; in-patient
stays; use of social services; and disability payments
received. Participant costs include: travel; over-thecounter medication and therapies; use of private therapies
and health care; loss of earnings; and additional childcare
and domestic help. Societal costs include: the value of
time off work; and services provided by the voluntary
sector. QALYs were estimated from responses to the EQ5D obtained at baseline, 6 and 12 months.
Complete cost and QALY data were available for 368 (78%)
participants: 186 (79%) intervention and 182 (77%)
control. Our provisional estimate of incremental cost per
QALY gain is £18,300. This is likely to be conservative
because of bias introduced by missing data. Further
110
analyses planned include the estimation of participant and
societal costs. We will also report the results of imputing
missing data and sensitivity analyses of assumptions.
S44-04
Patients’ experiences of CBT and usual care for
treatment resistant depression
Katrina Turner1
1
University of Bristol, United Kingdom
The COBALT trial included a nested qualitative study that
entailed conducting in-depth interviews with trial participants.
These interviews aimed to: (i) explore patients’ views and
experiences of CBT; (ii) identify patients’ reasons for completing
or not completing therapy; and (iii) describe ‘usual care’ for this
patient group. The data gathered provided another standpoint
from which to evaluate the intervention and highlighted possible
reasons for the trial’s quantitative findings.
The interviews were held with patients who had completed
their 6 month primary outcome measures for the trial.
Patients were purposefully sampled to ensure interviews
were held with individuals in both arms of the trial. Within
this sampling approach we aimed for maximum variation
in relation to study site (Glasgow, Bristol and Exeter),
patients’ age, gender, socio-economic background and
whether or not their BDI score had improved by 6 months
post-randomisation. When sampling patients from the
intervention arm, we also aimed to sample those who
varied in their levels of treatment adherence, i.e. had or
had not completed therapy.
The interviews were conducted in patients’ own homes or
in their own GP surgery. A topic guide was used to ensure
consistency across the interviews. Most interviews lasted
about an hour. With patient consent, they were audio taped
and fully transcribed. Data were then analysed thematically.
The software package ATLAS.ti was used to aid analysis.
Data collected ended when data saturation had been reached,
i.e. no new themes emerged from the analysis.
Forty patients were interviewed in total. 17 had completed
therapy, 9 had not and 14 were interviewed having been
randomised to the usual care arm. It was apparent that patients
in intervention arm felt they had benefitted from receiving CBT.
These benefits related to having had someone they felt able to
talk to and who they viewed as non-judgemental and skilled
in providing appropriate advice and support; learning to
question their negative thoughts; feeling more able to manage
their depression and communicate with others; and feeling
more motivated to do things, such as exercise, which could
also improve their mood. However, patients also described
how they had found CBT a challenging and difficult process
at times, and had struggled to complete homework tasks for
both emotional and practical reasons. These difficulties were
reasons why some patients had not completed their course
EABCT 2012
Conditional beliefs in patients with treatment
resistant depression
Samantha Green1
1
University of Bristol, United Kingdom
The COBALT trial used a CBT approach as described by
Beck et al. (1979) with elaborations from Moore & Garland
(2003) which were specifically designed to overcome the
avoidance and resistance often found in patients with
treatment resistant depression. CBT postulates three levels
of cognition: unconditional core beliefs; conditional beliefs;
and negative automatic thoughts. It has been suggested
that in order to treat treatment resistant depression using
CBT, it is helpful to work at the intermediate level of
conditional beliefs (Mooney & Padesky, 2000; Moore &
Garland, 2003) in order to effect longer-lasting change.
Conditional beliefs are also known as ‘underlying
assumptions’ or ‘rules for living’, and usually stated in
an «If…then…» format. They drive behaviour and may
therefore maintain negative core beliefs and influence
engagement in therapy. This qualitative study reviewed
the conditional beliefs recorded in the therapist notes of
a random sample of 50 trial participants (stratified by age
and gender) across the 3 study sites (Bristol, Exeter and
Glasgow). The aim of the study was to explore and describe
the types of conditional beliefs found amongst patients with
treatment resistant depression, and identify if there were any
prominent themes.
The final sample was 29 women (mean age: 50 years)
and 21 men (mean age: 49 years). 284 conditional beliefs
were extracted from the clinical notes and framework
analysis (Ritchie & Spencer, 1994) was used to provide
a systematic method of organising the data to identify key
themes. The researchers extracted the data together, then
worked independently to organise the beliefs according
to themes. Any differences in themes were identified and
discussed. Themes were cross-referenced to determine
agreement between the researchers. A third, independent
researcher reviewed the data and resolved discrepancies.
It is hoped that the results will improve clinical
understanding of this client group.
EABCT 2012
The effect of stress and emotion suppression on
neuropsychological performance: A comparison
between patients with social anxiety disorder
and healthy controls
Mia Skytte O’Toole1; Anders Degn Pedersen2; Esben
Hougaard1; Nicole K Rosenberg1
1
Aarhus University Hospital Risskov, Denmark; 2Hammel
Neurorehabilitation and Research Centre, Denmark
Introduction: A systematic review of cognitive dysfunctions
in patients with social anxiety disorder (SAD) revealed
decreased visuospatial performance. There was also some
indication of verbal memory difficulties. However, a test
situation is likely anxiety provoking for patients with SAD,
and situational factors, which could compromise cognitive
performance, should be explored.
Objectives: The objectives of the study were to compare
patients with SAD with healthy controls (HCs) on
neuropsychological performance before and after a stress
induction, and to investigate the effect of anxiety and emotion
suppression on cognitive functioning.
Methodology: Forty-two HCs were matched on gender and
education to 42 patients with SAD. A neuropsychological test
battery was administered before and after a stress induction
(future speech to be video-recorded).
Results: At baseline, participants with SAD performed worse
than HCs on several neuropsychological tests, but controlling
for state anxiety and state emotion suppression, only the
difference on visuospatial construction remained. After the
stress induction, all between group differences in the change
scores in neuropsychological performance also disappeared
when controlling for state anxiety and state emotion
suppression. State emotion suppression was associated with
a smaller increase in working memory and larger decrease in
verbal learning.
Discussion: The results are in line with previous literature
that finds decreased visuospatial construction performance in
patients with SAD. One may speculate that other situational
factors, such as the engagement in self-focus, could occupy
visual attentional resources, resulting in poor visuospatial
performance. Taken together, cognitive difficulties seem best
accounted for by disorder-related situational activities, and the
study thus reveals very little indication that patients with SAD
have cognitive impairments.
Conclusion: Participants with SAD showed poorer
visuoconstruction ability than HCs, but did not show clinically
significant decreased performance. Emotion suppression was
a better predictor of neuropsychological performance than
anxiety.
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S45-01
Symposium
of CBT. Other reasons for not completing were the need to
prioritise other commitments and feeling too depressed
to talk to someone about their feelings. Data gathered on
patients’ experiences of usual care indicated that this mainly
entailed taking antidepressants, although many of the patients
interviewed also talked about having had counselling in the
past. These data also highlighted that some patients had
received invaluable support from family and friends, and had
developed strategies/skills to help them cope, for example,
avoiding certain situations and learning how to meditate.
Symposium 45 - Neurocognition in
anxiety disorders and schizophrenia –
implications for future treatment
Symposium
45
S45-02
S45-03
Do poor memory and executive functions in
patients with Obsessive Compulsive Disorder
increase the risk of a poor response to Cognitive
Behavioural Therapy?
Sanne Kjær Vandborg1; Birgit Egedal Bennedsen1; Anders
Degn Pedersen1,2; Per Hove Thomsen1
1
Aarhus University Hospital Risskov, Denmark; 2Hammel
Neurorehabilitation and Research Centre, Denmark
Introduction: Up to 50% of patients with Obsessive
Compulsive Disorder (OCD) do not have a clinically
significant outcome of Cognitive Behavioral Therapy
(CBT). Deficits in memory and executive functions may
limit a patient’s ability to comprehend, remember and use
issues discussed in psychotherapy to make behavioral
changes, thereby possibly contributing to a poor treatment
outcome
Objectives: The objective of this study was to investigate
whether poor memory and executive functions in OCDpatients increase the risk of a poor response to CBT.
Methodology: Thirty-nine OCD-patients were assessed
with the Yale-Brown Obsessive Compulsive Scale (YBOCS)
to assess OCD symptom severity before and after CBT, and
with neuropsychological tests of memory and executive
functions before CBT. Major responders were defined as
having ≥ 30% reduction in Y-BOCS scores after CBT.
Results: There was a greater risk of a poor response to
CBT for OCD-patients with poorer performance on Rey
Complex Figure Test (RCFT), a neuropsychological test
of visuo-spatial memory and organizational strategies
(OR=1.29, 95% CI=1.01-1.65, p=.044). There were no
statistically significant differences between major (56%)
and minor responders (44%) on any demographic or
baseline psychopathological variables, nor on any other
neuropsychological tests of memory and executive
functions.
Discussion: Difficulties organizing, encoding and
retrieving complex information may make it more difficult
for OCD-patients to infer the most relevant messages from
CBT, thereby decreasing their response rate. Integrating
cognitive remediation strategies and CBT might improve
the number of OCD-patients with a good response to CBT.
Conclusion: Poor performance on a neuropsychological
test of visuo-spatial memory and organizational strategies
increased the risk of a poor response to CBT in OCDpatients.
Classification of OCD patients and healthy
subjects by automated MRI measures of regional
brain volume
Tue Hartmann1; Birgit Egedal Bennedsen1; Peter Mondrup
Rasmussen1; Poul Videbech1
1
Aarhus University Hospital Risskov, Denmark
Introduction: Several neuroimaging studies of OCD have
reported structural grey matter differences between OCDpatients and healthy controls.
Objectives: The objective of this study was to investigate
whether these group differences could be used in the
classification of individuals as OCD or healthy controls,
respectively.
Method: Thirty patients where included their primary
diagnosis was OCD and they had a Y-Bocs ≥ 16 and no
comorbid psychiatric illnesses other than mild depression
(Ham-D < 17) or anxiety disorders. Thirty-one controls
were matched to the patient group by gender, age and
educational level. All subjects were MRI-scanned in a
3-tesla GE-scanner using an FSPGR-3D sequence for each
subject 144 slices with a slice thickness of 1.2mm were
recorded with an in plane resolution of 0.94*0.94mm2.
Images where realigned, segmented, coregistered and
smoothed with a 12mm FWHM kernel using SPM8.
Only grey matter images were included in this analysis.
Templates where created by generating a mean for each
group omitting the subject about to be classified. Each
subject where classified by determining which group
template gave the best fit.
Results: We were unable to classify the subjects by the
structure of their grey matter.
Initially we achieved an accuracy of 74% but as we
improved the preprocessing steps this accuracy fell well
belove significance at a accuracy of 52%.
Discussion: We found that individuals could not be
correctly classified as OCD or control by the structure
of their grey matter beyond chance. Thus this method is
not suited for diagnostic purposes and is contradictory to
previous results.
Conclusion: OCD patients cannot be classified by the
structure of their grey matter.
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EABCT 2012
An investigation of metacognitive beliefs and
course of illness within schizophrenia
Stephen F. Austin1; Ole Mors1; Roger Hagen2; Rikke Gry
Secher3; Merete Nordentoft3
1
Århus University Hospital, Denmark; 2Norwegian
University of Science & Technology, Trondheim, Norway;
3
University of Copenhagen, Denmark
Introduction: Metacognition is concerned with the
awareness and regulation of cognition. The S-REF model
(Self-Regulatory Executive Function) model proposes that
maladaptive metacognitive beliefs may be implicated in the
development and maintenance of psychological disorders.
Studies have shown that elevated metacognitive beliefs
are associated with the predisposition and occurrence of
positive symptoms in psychosis.
Metacognitive beliefs may lie on a continuum, where
the severity of maladaptive metacognitive beliefs may be
directly associated with different phases in the development
and maintenance of schizophrenia
Aim: The study was concerned with examining the
association between the occurrence of maladaptive
metacognitive beliefs and different courses of illness in
schizophrenia
Method: The sample consisted of 547 people with first
episode psychosis recruited as part of the OPUS trial
(1998-2000). The study design was cross-sectional,
where information about course of illness over the last two
years and current metacognitive beliefs was collected
Results: A total of 347 participants were interviewed at
10-year follow-up. There was a significant correlation
between delusions and hallucinations and all types of
maladaptive metacognitive beliefs. Levels of maladaptive
metacognitive beliefs varied as a function of course
of illness (non-psychotic, episodic and continuously
psychotic). The multinominal regression anlaysis was
signifincant, X2 (10, N=348) =55.08, p<.0001, where
metacognitive beliefs explained 12% of the variance
displayed in course of illness.
Conclusion: There was a significant relationship between
course of illness and maladaptive metacognitive beliefs
within schizophrenia spectrum disorders. Interventions
designed to reduce maladaptive metacognitions may
potentially reduce positive symptoms and impact on
course of illness within schizophrenia
Social Cognitive Deficits in First-Episode
Schizophrenia: Implications for CBT
Vibeke Bliksted1; Birgitte Fagerlund2; Torben Lund1; Chris
Frith3; Poul Videbech1
1
Aarhus University Hospital Risskov, Denmark;
2
University of Copenhagen, Denmark; 3University College
London, United Kingdom
Introduction: There is growing evidence that aspects of
social cognition, primarily social perception, may serve
as a mediator between neurocognition and functional
outcome in schizophrenia.
Objectives: This PhD project focuses on theory of mind
(the ability to represent human mental states and/or make
inferences about other’s intentions) and social perception
(the ability to process nonverbal, paraverbal, and/or verbal
cues to make inferences about complex or ambiguous
social situations).
Methodology: Thirty-six patients with first-episode
schizophrenia and 36 matched healthy controls were neuro
psychologically tested. Theory of mind was measured
by The Hinting Tasks and Animated Triangles. Social
perception was measured by a Danish translation of TASIT
(part 2A) showing film clips from everyday life in either a
sincere or a sarcastic version.
Results: Patients had significant lower current and
premorbid IQ and their level of neurocognitive functioning
were more than 1 SD below the healthy controls. Patients
performed significantly worse that the controls on all the
social cognitive tests. However there were no difference
between patients and controls on the sincere film clips.
Patients had different social cognitive “profiles”.
Discussion: Traditionally psychoeducation and CBT in
psychosis focus primarily on positive symptoms, negative
symptoms and to a smaller degree neurocognitive deficits,
without including the social cognitive deficits. There is
a need for this to be changed in the future so that both
patients and therapists achieve a better understanding of
the patients’ specific social cognitive difficulties and can
take these into account when performing CBT. CBT should
be combined with social cognitive remediation when such
deficits are present.
Conclusion: CBT in psychosis should be combined
with an examination of the patients’ idiosyncratic social
cognitive deficits.
EABCT 2012
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45
S45-05
Symposium
S45-04
Symposium 46 - Social anxiety disorder:
brain imaging, genetics and costeffective treatment via the Internet
S46-01
Symposium
46
Using Functional Brain Imaging to Measure
Effects by Internet-Delivered Cognitive Behaviour
Therapy and Cognitive Bias Modification in
Social Anxiety Disorder - an RCT
Kristoffer NT Månsson1, Per Carlbring1,2, Andreas Frick3,
Jonas Engman3, Carl-Johan Olsson2,4, Owe Bodlund2,
Tomas Furmark3 & Gerhard Andersson1,4
1
Linköping University, Sweden; 2Umeå University,
Sweden; 3Uppsala University, Sweden; 4Karolinska
Institutet, Stockholm, Sweden
Introduction: Randomized clinical trials (RCT) have
yielded promising results for both internet-delivered
Cognitive Behaviour Therapy (iCBT) and Cognitive Bias
Modification (CBM). The aim of this study was to compare
effects by these treatments using functional Magnetic
Resonance Imaging (fMRI).
Method : A total of 26 persons diagnosed with SAD
were randomized to one of the two conditions: iCBT or
CBM. The CBM was conducted 8 times during a 4 week
period. This dot probe task involved 160 trials of disgust
or neutral facial expressions during 500 msec. iCBT was
delivered over a period of 9 weeks, and consisted by
standard CBT interventions as cognitive restructuring,
behavioural experiment, exposure and shifting attention.
An experimental paradigm known as the Hariri emotional
face task, matching different expressions as anger, fear,
surprised and neutral faces, was used in brain image
acquisition. Activations in fear related networks, such as
amygdalae, insular, anterior cingulate cortex and prefrontal
cortex has been reported by this paradigm. Hyperactivity in
related networks has been reported in patients with social
anxiety disorder.
Results: Brain imaging data were collected pre and
post treatment, using a GE 3.0T (T2* weighted), with a
32-channel head coil. A repeated measure with a flexible
factorial design is presented. Analyzing primary and
secondary outcome measures was completed by March
2012.
Discussion: Brain imaging and behavioural data will be
discussed. Conclusion: This is the first study exploring
change in brain mechanism by two interesting internetdelivered treatments in social anxiety disorder.
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S46-02
Internet-based Cognitive Behavior Therapy vs.
Cognitive Behavioral Group Therapy for Social
Anxiety Disorder: A Randomized Controlled Noninferiority Trial
Erik Hedman1, Gerhard Andersson1,2, Brjánn Ljótsson1,
Erik Andersson1, Christian Rück1, Ewa Mörtberg3; Nils
Lindefors1
1
Karolinska Institutet, Stockholm, Sweden; 2Linköping
University, Sweden; 3Stockholm University, Sweden
Background: Cognitive behavioral group therapy (CBGT)
is an effective, well-established, but not widely available
treatment for social anxiety disorder (SAD). Internetbased cognitive behavior therapy (ICBT) has the potential
to increase availability and facilitate dissemination of
therapeutic services for SAD. However, ICBT for SAD has
not been directly compared with in-person treatments
such as CBGT and few studies investigating ICBT have
been conducted in clinical settings.
Objective: To investigate if ICBT is at least as effective as
CBGT for SAD when treatments are delivered in a psychiatric
setting. Methods: Randomized controlled non-inferiority
trial with allocation to ICBT (n=64) or CBGT (n=62) with
blinded assessment immediately following treatment and
six months post-treatment. Participants had suffered from
SAD for 21 years (SD=12) on average. The Liebowitz Social
Anxiety Scale (LSAS) was the primary outcome measure.
Results: Both groups made large improvements. At
follow-up, 41 (64%) participants in the ICBT group were
classified as responders (95% CI, 52%-76%). In the CBGT
group, 28 participants (45%) responded to the treatment
(95% CI, 33%-58%). At post-treatment and follow-up
respectively, the 95 % CI of the LSAS mean difference was
0.68-17.66 (Cohen’s d between group=0.41) and -2.5115.69 (Cohen’s d between group=0.36) favoring ICBT.
Conclusions: ICBT delivered in a psychiatric setting can
be as effective as CBGT in the treatment of SAD and could
be used to increase availability to CBT.
S46-03 Cost-effectiveness of Internet-based
cognitive behavior therapy vs. cognitive
behavioral group therapy for social anxiety
disorder: Results from a randomized controlled
trial
Erik Andersson1; Erik Hedman1; Brjánn Ljótsson1;
Gerhard Andersson1, 2; Christian Rück1; Nils Lindefors1
1
Karolinska Institutet, Stockholm, Sweden; 2Linköping
University, Sweden
Introduction: Social anxiety disorder (SAD) is highly
prevalent and associated with a substantial societal
EABCT 2012
S46-04
Clinical and genetic outcome determinants of
Internet- and group-based cognitive behavior
therapy for social anxiety disorder
Evelyn Andersson1; Erik Hedman1; Brjánn Ljótsson1;
Gerhard Andersson1, 2; Martin Schalling1; Niels
Lindefors1; Christian Rück1
1
Karolinska Institutet, Stockholm, Sweden; 2Linköping
University, Sweden
Objective: No study has investigated clinical or genetic
predictors and moderators of Internet-based cognitive
behavior therapy (ICBT) compared with cognitive
behavioral group therapy for (CBGT) for SAD. Identification
of predictors and moderators is essential to the clinician
in deciding which treatment to recommend for whom.
We aimed to identify clinical and genetic (5-HTTLPR,
COMTval158met, and BDNFval66met) predictors and
moderators of ICBT and CBGT.
Method: We performed three types of analyses on data
from a sample comprising participants (N=126) who had
undergone ICBT or CBGT in a randomized controlled trial.
Outcomes were i) end state symptom severity, ii) SAD
diagnosis, and iii) clinically significant improvement.
Results: The most stable predictors were working full
time, having children, less depressive symptoms, higher
expectancy of treatment effectiveness, and adhering
to treatment. None of the first three polymorphisms
EABCT 2012
(5-HTTLPR, COMTval158met, and BDNFval66met)
were associated with treatment outcome. However, in
the extended genetic analysis one polymorphism were
associated with treatment outcome.
Conclusion: We conclude that demographic and clinical
factors may play an important role as predictors of
treatment outcome. The investigated gene polymorphisms
were inconclusive and will hereby be discussed.
Requested versus scheduled support in Internetdelivered CBT for social anxiety disorder: A
randomized controlled trial
Gerhard Andersson1,2, Per Carlbring1,3, Cecilia Olsson
Lynch4, Kajsa Sundling4, Tomas Furmark4 on behalf of the
SOFIE Research Group
1
Linköping University, Sweden; 2Karolinska Institutet,
Stockholm, Sweden; 3Umeå University, Sweden; 4Uppsala
University, Sweden
Background: Guided internet-delivered CBT has substantial
empirical support in the treatment of social anxiety disorder
and guided ICBT appears to work better than unguided. The
aim of this study was to investigate if requested support is
enough when compared with the usual scheduled support
which is linked to homework assignments.
Methods: Participants were recruited from a larger RCT and
had been on a waiting list for treatment. We included 100
persons who were interested in receiving the treatment and
who had SAD ongoing symptoms after the waiting period.
Treatment lasted for 9 weeks. In the scheduled support group
one therapist was responsible during the whole treatment and
in the requested support a team of therapists had a schedule
and did not respond with their names. The average therapist
time per patient and week was 14 minutes in the scheduled
support group and 1 minute in the requested support group,
mainly caused by the fact that only 15 used the option to
contact the research team for support.
Results: There were differences at pretreatment and
differences were analyzed with ancova. Results showed
large within group effects for both groups, d=0.88
and d=0.85 for the scheduled and requested support
respectively on the main outcome measures LSAS-SR
(Liebowitz Social Anxiety Scale Self Report). Overall,
both groups improved even if there were tendencies for
the scheduled support group to benefit slightly more.
Moreover, there were no differences in dropout rate with
four dropping out in the scheduled support group and 5 in
the requested support group.
Conclusion: This initial RCT gives preliminary evidence
for the effects of ICBT for SAD when support is given on
demand. This is likely to reduce the costs of providing
support while retaining the effects.
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S46-05
Symposium
economic burden, primarily due to high costs of
productivity loss. Cognitive behavior group therapy
(CBGT) is an effective treatment for SAD and the most
established in clinical practice. Internet-based cognitive
behavior therapy (ICBT) has demonstrated efficacy in
several trials in recent years. No study has however
investigated the cost-effectiveness of ICBT compared to
CBGT from a societal perspective, i.e. an analysis where
both direct and indirect costs are included.
Method: We conducted a randomized controlled trial
where participants with SAD were randomized to ICBT (n
= 64) or CBGT (n = 62). Economic data were assessed
at pre-treatment, immediately following treatment and six
months after treatment.
Results: Results showed that the gross total costs were
significantly reduced at six- month follow-up, compared
to pre-treatment in both treatment conditions. As both
treatments were equivalent in reducing social anxiety and
gross total costs, ICBT was more cost-effective due to
lower intervention costs.
Discussion: Cost-effectiveness methodology and CBT
will be discussed. Conclusion: We conclude that ICBT can
be more cost-effective than CBGT in the treatment of SAD
and that both treatments reduce societal costs for SAD.
Symposium 47 - Recent advances in
Exposure-based psychotherapy for
anxiety and depression
S47-01
Symposium
47
Fostering emotional processing in CognitiveBehavioral Therapy – a randomized-controlled
trial of Exposure-Based Cognitive Therapy
(EBCT)
Martin Grosse Holtforth1, Tobias Krieger1; David
Altenstein1; Nadja Doerig1
1
University of Zurich, Switzerland
Background: Exposure-Based Cognitive Therapy for
depression (EBCT) has been developed to accomplish
more sustainable outcome by fostering emotional
processing in a cognitive-behavioral context (A. Hayes,
et al., 2005). In this trial, EBCT differed from CBT by the
employment of emotion-focused techniques in the middle
phase of therapy.
Objective : We will present the results of a randomized
controlled comparison of EBCT with cognitive-behavioral
therapy (CBT).
Methods : 84 depressed psychotherapy outpatients
(EBCT: N=40; CBT: N=44) completed a manualized therapy
of 22 individual sessions offered by therapists offfering
treatments in both conditions. Outcome was assessed
by standardized diagnostics, as well as self-reports of
depressive symptomatology and well-being before and
after treatment. Symptom course and therapy processes
was assessed by brief self-reports before each session, as
well as patient and therapists reports after each session,
respectively.
Results: Whereas therapist reported more EBCT-specific
interventions in EBCT and more CBT-specific interventions
in CBT, EBCT and CBT did not differ regarding the use of
non-specific interventions. Differences between phase 1
and 2 regarding emotional processing were larger in EBCT
than in CBT EBCT. However, EBCT and CBT did not differ
significantly regarding symptom relief, improvement of
well-being, and the number of drop-outs. In EBCT, peak
levels of emotional processing predicted better outcomes.
Discussion: Results will be discussed with respect
to mechanisms of change in EBCT and CBT, practical
implications, and future research.
116
S47-02
Exposure to traumatic memories in social
phobia: Evaluation of a single-session
intervention
Jennifer Wild1; Ann Hackman2; David M Clark1
1
University of Oxford, United Kingdom; 2Oxford Cognitive
Therapy Center, United Kingdom
People with social phobia are terrified of social and
performance situations. They often have negative images
of how they come across to other people. Research
suggests that the images may be linked to early memories
of unpleasant social experiences that cluster around the
onset of the disorder. We assessed the impact of rescripting
such memories. Patients with social phobia attended two
sessions, one week apart. The first was a control session
in which their images and memories were discussed but
not modified. The second was an experimental session in
which patients were exposed to their traumatic memories
in imagery. Cognitive restructuring followed by an
imagery with rescripting procedure was used to update the
memories. There was no change observed after the control
session. The experimental session led to significant
improvement in negative beliefs, image and memory
distress and vividness, fear of negative evaluation and
anxiety in feared social situations. The results suggest that
rescripting socially traumatic memories in imagery may
be a beneficial component of treatment for social phobia.
Exposure to these memories in imagery forms a part of the
imagery rescripting procedure.
S47-03
Sleep enhances exposure therapy
Birgit Kleim1; Frank H Wilhelm2,3; Lena Temp1; Jürgen
Margraf4; Brenda Wiederhold5; Björn Rasch1
1
University of Zurich, Switzerland; 2University of
Salzbourg, Austria; 3Technical University of Brunswick,
Germany; 4Ruhr-Universität, Bochum, Germany;
5
University of California, San Diego, USA
Background: Sleep benefits memory consolidation.
Here, we tested the beneficial effect of sleep on memory
consolidation following exposure psychotherapy of phobic
anxiety.
Methods: Forty individuals diagnosed with spider phobia
according to DSM-IV underwent a one-session virtual
reality exposure treatment. Following the treatment, they
were randomly assigned to a sleep group (napping for 90
minutes) or a wake group (watching a neutral video for
90 minutes). Main outcome parameters were self-reported
fear and negative spider-related cognitions. These were
EABCT 2012
Exposure therapy in spider phobics does not lead
to an endogenous cortisol response
Johanna Lass-Hennemann1; Tanja Michael1
1
Saarland University, Saarbrücken, Germany
Background: Previous experiments in patients with
phobia have shown that the administration of cortisol
reduces fear in phobic situations and enhances extinctionbased exposure therapy. One major criticism of this
new therapeutic approach is that exposure therapy is a
stressful event and leads to a strong endogenous cortisol
response in itself. This would make exogenous cortisol
administration unnecessary or even contra-productive.
However, there are no empirical studies investigating the
endogenous cortisol response during exposure therapy.
Methods: 51 individuals meeting DSM IV criteria for
specific phobia (animal type) underwent a 3 hour one
session exposure therapy. Basal cortisol levels were
collected using a hair sample and two daily saliva cortisol
profiles. Saliva cortisol was collected prior to exposure
therapy and every 30 minutes during exposure therapy.
Participants returned for a posttreatment assessment one
week after the therapy session and a follow up assessment
three months after the therapy session.
Results: There was no significant increase in endogenous
cortisol levels during therapy. Data of basal cortisol levels
and their possible influence on therapy outcome are still
under investigation and will be presented at the conference.
Discussion: Our results show that exposure therapy does
not lead to a significant increase in endogenous cortisol
levels. Thus, the idea that exogenous cortisol administration
during exposure therapy is unnecessary due to an
endogenous cortisol response cannot be supported.
EABCT 2012
S48-01
Früherkennung und nachhaltige Behandlung
beginnender psychotischer Störungen
Gregor Berger1
1
Integrierte Psychiatrie Winterthur – Zürcher Unterland
Adoleszentenpsychiatrie ADP, Switzerland
Früherkennung und Frühintervention bei Personen mit
einem erhöhten Psychoserisiko Psychotische Störungen
haben eine teilweise mehrjährige Vorläuferphase mit
unspezifischen, subtilen Veränderungen im Denken, Fühlen
und Wahrnehmen, die dem akuten Krankheitsausbruch
vorausgehen und häufig mit einer beträchtlichen
Einschränkung des alltäglichen Funktionierens verbunden
sind. Die Betroffenen erleben diese Veränderungen
als belastend, resultieren häufig in Schwierigkeiten in
zwischenmenschlichen Beziehungen und hindern bei
der Bewältigung typischer Entwicklungsaufgaben. Eine
verzögerte Erkennung und Behandlung dieser Phase der
Erkrankung kann jedoch mit lebenslangen biopsychosozialen
Konsequenzen assoziiert sein. Aus diesen Gründen kommt
der Früherkennung sowie der Entwicklung und Evaluation
von Interventionen zur indizierten Prävention bei Personen
mit einem erhöhten Psychoserisiko grosse Bedeutung zu.
In der Schweiz konnten sich bereits erste Früherkennungsund Frühbehandlungszentren etablieren. Eine integrative
Behandlung innerhalb eines Kompetenzzentrums von der
akuten bis zur rehabilitativen Phase, um die Nachhaltigkeit
der Therapie auch in der kritischen Phase der Erkrankung
zu gewährleisten, konnte bislang jedoch nur ansatzweise
umgesetzt werden.
S48-02
Prädiktoren für eine psychotische
Erstmanifestation
Stephan Ruhrmann1
1
University Hospital University of Cologne, Germany
Die Behandlungsmöglichkeiten manifester psychotischer
Störungen können nach wie vor nicht als ausreichend
angesehen werden. Wesentlich ist daher die Senkung
der Inzidenz mittels präventiver Maßnahmen. Das hierfür
gegenwärtig als am ehesten zielführend bewertete
Konzept, die indizierte Prävention, beruht auf der
Identifikation klinischer Anzeichen und Symptome eines
erhöhten Psychoserisikos. Hierbei haben sich vor allem
zwei Ansätze als erfolgreich erwiesen, die überwiegend
auf subschwelligen Formen von Positivsymptomen
117
48
S47-04
Symposium 48 - Früerkennung und
Früintervention Psychosen
Symposium
tested during approaching a caged live tarantula in a
behavioral approach task (BAT). BATs were conducted
pre-therapy, immediately after sleep/wake condition and at
1-week follow-up.
Results: We show that a nap following exposure therapy
compared with wakefulness leads to better reductions in
self-reported fear, p= .045, d= .47, and catastrophic spiderrelated cognitions, p= .026, d= .53, during approaching a
live tarantula in the BAT, both tested after 1 week. Both
reductions were associated with greater percentages of
stage 2 sleep.
Conclusions: Our results indicate that sleep following
successful psychotherapy, such as exposure therapy,
improves therapeutic effectiveness, possibly by
strengthening new non-fearful memory traces established
during therapy. These results help to further advance
therapy procedures and to better understand mechanisms
of change in anxiety therapy.
beruhenden UHR-Kriterien und die als substratnäher
und den UHR-Kriterien vorauslaufend konzipierten
kognitiv-perzeptiven
Basissymptom-Kriterien.
Um
die prognostische Validität dieser Ansätze weiter zur
verbessern, scheinen neben Mehrebenenmodellen
insbesondere die im Rahmen der European Prediction of
Psychosis Study (EPOS) entwickelte Risikostratifikation
auf Basis prognostischer Scores sowie eine Kombination
der Kriteriensätze aussichtsreich zu sein. Da im begrenzten
Untersuchungszeitraum der bisherigen Studien ein
relevanter Anteil der Risikopersonen keine Psychose
entwickelte, ist ein zunehmendes Interesse am Verlauf in
dieser (noch) nicht übergegangenen Gruppe entstanden.
Dabei hat sich gezeigt, dass es jenseits der psychotischen
Erstmanifestation noch andere schwerwiegende
ungünstige Entwicklungen stattfinden, vor allem im
Sinne eines anhaltenden Funktionsverlusts und einer
persistierenden Negativsymptomatik.
48
Symposium
S48-03
Neurobiologie der frühen Phasen von Psychosen
– Erkenntnisse durch Neuroimaging
Stefan Borgwardt1
1
Universitäre Psychiatrische Kliniken Basel, Switzerland
Bei Personen mit einem erhöhten Psychoserisiko
Neurobiologie der frühen Phasen von Psychosen –
Erkenntnisse durch Neuroimaging Innerhalb der letzten
zehn Jahre konzentrierten sich Forschungsbemühungen
zunehmend darauf, strukturelle und funktionelle
neurobiologische Hirnprozesse, die dem Übergang von
einem Risikostadium zur psychotischen Erstmanifestation
zugrunde liegen, zu identifizieren. Trotz methodologischer
Unterschiede, deuten die bildgebende Studien bei
Personen mit einem erhöhten Risiko für die Entwicklung
einer Psychose auf strukturelle und neurochemische
Abnormitäten im Bereich des präfrontalen, cingulären,
mediotemporalen sowie dem zerebellaren Kortex hin.
Diese Veränderungen erweisen sich als qualitativ ähnlich,
aber weniger stark ausgeprägt als bei Personen mit
einer psychotischen Erstmanifestation. Diese Ergebnisse
können das Verständnis der neurobiologischen Korrelate
der Vulnerabilität für die Entwicklung einer Psychose
verbessern und damit zu einer Optimierung der
Früherkennung und –intervention beitragen.
118
S48-04
Integrierte Kognitive Remediationstherapie bei
Personen mit einem erhöhten Psychoserisiko
Stefanie J. Schmidt1; Daniel R. Mueller1; Volker Roder1
1
Universität Bern, Switzerland
Bei mindestens 75% der Personen, die später eine
psychotische Störung entwickeln, geht dem akuten
Krankheitsausbruch
eine
Prodromalphase
mit
unspezifischen, subtilen Veränderungen im Bereich
des Denkens, der Gefühle, der Wahrnehmung und des
Verhaltens voraus. Dennoch dauert diese unbehandelte
Prodromalphase derzeit durchschnittlich mehr als fünf
Jahre an. Eine verzögerte Behandlung der genannten
präpsychotischen Beeinträchtigungen ist jedoch mit
einer Vielzahl ungünstiger Effekte assoziiert. Aus diesen
Gründen kommt der Entwicklung und Evaluation von
Interventionen zur indizierten Prävention bei Personen mit
einem erhöhten Psychoserisiko grosse Bedeutung zu.
Im Gegensatz zu den schon vorhandenen kognitivbehavioralen Therapieansätzen liegen für die
Kognitive Remediationstherapie, die direkt auf eine
Verbesserung kognitiver Funktionen abzielt, noch keine
Wirksamkeitsnachweise für die Frühintervention vor.
Neue Studienergebnisse unterstützen aber die Bedeutung
kognitiver Funktionen als Vulnerabilitätsindikatoren
und intermediäre phänotypische Marker innerhalb
ätiologischer Erklärungsmodelle einer schizophrenen
Erkrankung. Dafür spricht, dass Personen, die später
die Diagnose einer Schizophrenie erhielten, schon
in der Prodromalphase der Erkrankung neuro- und
sozialkognitive Funktionseinbussen aufweisen. Auch
psychiatrisch unauffällige, biologische Verwandte
schizophren Erkrankter sind zumindest teilweise
beeinträchtigt. Kognitive Funktionen erwiesen sich zudem
als wichtige Prädiktoren für die Übergangsrate in eine
Psychose.
Vor diesem Hintergrund hat unsere Arbeitsgruppe
in Zusammenarbeit mit dem FETZ Bern einen
Gruppentherapieansatz für die Frühintervention für
Personen mit einem erhöhten Psychoserisiko entwickelt.
Dieser orientiert sich direkt an den speziellen Bedürfnissen
und Entwicklungsaufgaben der meist adoleszenten oder
jungen Erwachsenen. Neben Neurokognitionen (z.B.
Aufmerksamkeit, Gedächtnis) liegt der Fokus vor allem
auf der Verbesserung der selbstbezogenen und sozialen
Kognitionen (z.B. Theory of Mind, Emotionswahrnehmung)
sowie der sozialen Kompetenzen. Dieser integrative kognitive
Remediationstherapieansatz stellt eine Anpassung des
„Integrierten Psychologischen Therapieprogramms (IPT)“
und der „Integrierten Neurokognitiven Therapie (INT)“ für
schizophren Erkrankte dar. Seine Wirksamkeit wird in einer
randomisierten klinischen Studie im Vergleich zu einer
EABCT 2012
Integrierte Behandlung von PsychoseErsterkrankten im Rahmen des Soteria-Ansatzes
Holger Hoffmann1
1
Universitäre Psychiatrische Dienste Bern (UPD),
Switzerland
Soteria Bern ist in den nun 28 Jahren ihres Bestehens ihren
Grundsätzen – trotz veränderter Rahmenbedingungen –
treu geblieben und hat den von Luc Ciompi geprägten
Geist bewahrt. Gleichzeitig hat Soteria Bern in den
letzten Jahren ihr Angebot stark erweitert in Richtung
integrierte Behandlung. Akut an einer Psychose aus dem
schizophrenen Formenkreis Erkrankte werden somit nicht
mehr ausschliesslich stationär, sondern in zunehmendem
Masse tagesklinisch, ambulant und mittels Home
Treatment behandelt.
Über das Früherkennungs- und Therapiezentrum (FETZ
Bern), welches die Soteria Bern gemeinsam mit den
Universitären Psychiatrischen Diensten (UPD Bern)
seit Anfang 2010 betreibt, kommen wieder vermehrt
Ersterkrankte in die Soteria.
In diesem Referat wird der aktuelle integrierte
Behandlungsansatz der Soteria Bern vorgestellt und wie
dieser zukünftig speziell für Ersterkrankte weiter ausgebaut
werden soll.
EABCT 2012
S49-01
Auto-traitement par Internet avec guidance pour
les troubles du comportement alimentaire
Isabelle Carrard1; Patrick Rouget1, Tony Lam1, Alain
Golay1
1
Geneva University Hospitals, Switzerland
Objectif: Evaluer l’efficacité d’un auto-traitement basé sur
des techniques de thérapie cognitive et comportementale et
implémenté sur Internet pour la boulimie et l’hyperphagie
boulimique.
Méthode: Grâce à un projet européen, les Hôpitaux
Universitaires de Genève, en collaboration avec une
société informatique lausannoise, ont développé un
programme d’auto-traitement en ligne pour la boulimie et
l’hyperphagie boulimique. Il comprend des étapes incluant
théorie et exercices, à accomplir de manière séquentielle
avec la guidance par e-mail d’un psychologue. L’accès au
programme est restreint et nécessite une évaluation en
face à face au préalable.
Résultats: Une étude européenne menée sur 127
participantes souffrant de boulimie montre qu’après
quatre mois d’auto-traitement, la sévérité des troubles
du comportement alimentaire et la santé psychologique
s’étaient améliorées. Un quart des personnes ayant terminé
l’étude n’avaient plus de symptômes.
Une étude contrôlée randomisée menée sur 74
participantes souffrant d’hyperphagie boulimique a montré
une amélioration des scores aux échelles évaluant les
troubles du comportement alimentaire suite à six mois
d’auto-traitement, en comparaison d’un groupe contrôle.
Trente-cinq pourcent des participantes n’avaient plus de
symptômes. Ces améliorations se maintenaient après six
mois de suivi.
Conclusion: Ces résultats indiquent qu’un auto-traitement
pour les troubles du comportement alimentaire peut
être transféré sur Internet et rester efficace. Le suivi du
psychologue restreint la dissémination du programme
et une version sans guidance pourrait être évaluée. C’est
finalement le rapport coût/efficacité de ces outils qui
décidera de leur place dans la palette des prises en charge
offertes pour les troubles du comportement alimentaire.
119
49
S48-05
Symposium 49 - TCC – Nouvelles
applications
Symposium
aktiven Kontrollgruppe (unspezifische Gruppenaktivität)
untersucht. In diesem Symposium werden die ersten
vielversprechenden Ergebnisse einer Pilotstudie für die
Zielbereiche Kognitionen, Psychopathologie, soziale
Fertigkeiten sowie für das psychosoziale Funktionsniveau
präsentiert.
Symposium
49
S49-02
S49-04
Thérapie par Internet et alliance thérapeutique
Thomas Berger1
1
University of Bern, Switzerland
Au cours de ces dernières années, un large spectre
d’interventions basées sur Internet pour le traitement de
différents troubles psychiques a vu le jour. Ces approches
ont des caractéristiques très diverses et comprennent une
multitude d’interventions allant des programmes purement
self-help aux approches dites guided self-help et aux
thérapies réalisées par échanges d’emails. Dans cette
présentation, les différentes approches, leurs avantages et
désavantages et leurs bases empiriques vont être discutés.
Une attention particulière va être accordée à l’importance
du contact thérapeutique et de l’alliance thérapeutique au
sein de ces nouvelles approches.
Une approche en ligne de l’addiction au
Cannabis
Yasser Khazaal1; Monney Grégoire1; Coquard Olivier1;
Jean-François Etter2
1
Geneva University Hospital, Switzerland; 2University of
Geneva, Switzerland
Introduction: L’offre psychothérapeutique sur Internet
connaît une très forte expansion. Des traitements en ligne
ont été développés et validés notamment pour les troubles
anxieux, la dépression et les troubles alimentaires. Dans le
domaine de l’addiction au cannabis l’offre est plus limitée
et moins étudiée. Un développement sur Internet dans ce
domaine pourrait intéresser une partie des consommateurs
de cannabis.
Méthode: Les réflexions relatives à la création d’une offre
de traitement en ligne sont présentées et discutées. Les
méthodes de traitement et les mesures en ligne retenues
sont présentées.
Résultats: Les premières données relatives à l’utilisation
de cette offre en montre l’acceptabilité. Un projet en
préparation devrait permettre d’évaluer l’impact de cette
offre en ligne.
S49-03
Utilisation de la réalité virtuelle en thérapie
comportementale : de l’expérience laboratoire à
la pratique privée
Françoise Riquier1
1
Private practice, Lausanne, Switzerland
Depuis les années 1980, l’utilisation de la réalité virtuelle
s’est installée dans notre quotidien, devenant incontournable
dans de nombreuses activités de formation (apprentissage
de la conduite, entrainement des pilotes, des chirurgiens),
de conceptualisation (architecture, prototypes industriels),
de loisirs (jeux vidéo, films), culturelles (musées),
etc. Les environnements et l’interaction qu’offrent ces
techniques de réalité virtuelle ont suscité l’intérêt des
thérapeutes en thérapie comportementale et cognitive qui
y entrevoient de nouvelles possibilités pour faciliter leur
travail d’exposition. A partir de la fin des années ’90, des
expériences et des programmes thérapeutiques utilisant
la réalité virtuelle sont réalisés confirmant l’intérêt et
l’efficacité de cet outil dans le traitement de différentes
pathologies psychiatriques (PTSD, phobies, troubles
alimentaires…). Cependant, malgré ces résultats,
l’utilisation de la réalité virtuelle est restée limitée entre
les mains de quelques initiés, contrastant avec l’apparente
accessibilité dans d’autres domaines. Au travers de notre
expérience (recherche, traitement en pratique privée),
nous présenterons et discuterons les avantages et les
limites de ces techniques, les nouveaux développements
et les enjeux en pratique privée.
120
EABCT 2012
EABCT 2012
S50-01
The Cool Kids/Chilled Adolescents Anxiety
program: Preliminary results of a randomized
wait-list controlled trial
Kristian Arendt1, Mikael Thastum1
1
Aarhus University, Denmark
Introduction: The Cool Kids/Chilled Adolescents Anxiety
program is a manualized CBT program for treating anxiety
disorders in children and adolescents, developed and
evaluated at Macquarie University, Australia (Hudson et
al., 2009). The program was translated and implemented at
the Youth Anxiety Clinic at the Department of Psychology,
Aarhus University, Denmark, in 2009.
Objectives: The objective of the study is to evaluate
The Cool Kids/Chilled Adolescents Anxiety program in a
Danish context, and thereby as the first study independently
replicate the original Australian evaluation study (Hudson
et al., 2009).
Methodology: The study is a randomized wait-list
controlled trial aiming to include a total of 110 participants
(aged 7-15 years) with an anxiety diagnosis as the primary
diagnosis. Participants are randomly allocated into either a
3 month wait-list control condition or a treatment condition.
The treatment consists of 10 2-hour group sessions with
6 children and their parents. Results are measured by
independent diagnostic interviews with the children and
their parents at post-treatment and at 3-month follow-up,
ADIS-C/P (Albano & Silverman, 1996), as well as by selfreport child and parent scales pre- and post-treatment,
and at 3- and 12 month follow-up.
Results: At the time of the conference we expect to be
able to present preliminary post-treatment results from 80
families.
121
50
L’ordinateur au secours du psychothérapeute :
Le potentiel des techniques de modification des
biais cognitifs basées sur l’imagerie mentale
dans le traitement de la dépression
Arnaud Pictet1
1
University of Oxford, United Kingdom
Introduction: La dépression affecte un si grand
nombre de personnes dans le monde que de nouvelles
formes d’interventions plus économiques et plus
accessibles doivent être développées. Les techniques de
«Modification des Biais Cognitifs» (MBC) représentent à
ce titre un candidat potentiel pour le développement de
nouveaux traitements sur ordinateur de l’anxiété et de la
dépression. Une version spécifique de ces techniques vise
a promouvoir une vision optimiste du futur en entrainant
les personnes à générer des images mentales positives
en réponse à des situations émotionnelles ambigües.
Des études préliminaires effectuées sur des individus
dépressifs suggèrent que cette forme de MBC centrée sur
l’imagerie mentale pourrait être efficace dans la réduction
des symptômes de dépression.
Objectifs et méthodologie: Nous décrivons une étude
pilote visant a tester la faisabilité d’une version internet
de ce programme d’intervention administré a 8 patients
présentant un épisode actuel de dépression majeure. Le
programme MBC consistait en 12 sessions sur ordinateur
effectuées a domicile sur une période de 1 mois.
Résultats: Les résultats concernant l’efficacité du
programme MBC dans la réduction des symptômes
dépressifs et sur l’amélioration des biais cognitifs ainsi
que des capacités imagerie mentale seront présentés.
Discussion et conclusion: La discussion et conclusion
porteront sur l’efficacité de ce programme MBC dans la
réduction des symptômes dépressifs et sur son utilité
potentielle comme future intervention pour la dépression.
Symposium 50 - Stepped care in treatment
of child and adolescent anxiety
disorders
Symposium
S49-05
Symposium
50
S50-02
S50-03
Predictors of Outcome of Online Delivery of CBT
for Child and Adolescent Anxiety
Susan H Spence1; Renee Anderson2; Caroline Donovan1;
Sonja March2; Sam Prosser2
1
Griffith University, Brisbane, Australia; 2University of
Queensland, Australia
Introduction: The study examined predictors of outcome
following online CBT, with minimal (online) therapist
contact, in the treatment of child anxiety disorders.
Predictor variables included child characteristics (age,
gender, comorbidity, and age of onset, severity, duration
and type of disorder), parent and family characteristics
(parent mental health, relationship quality, family
environment, demographic variables), and therapy process
variables (working alliance and therapy compliance).
Objectives and Methodology: Participants were 132
children and adolescents aged 7 to 18 years who met
diagnostic criteria for an anxiety disorder. Children and
parents participated in an online CBT intervention (The
Brave Program) supported by brief, weekly emails and
a single, short phone call. Outcome was determined
from clinical anxiety disorder diagnoses, and ratings on
the Child Global Assessment Scale (CGAS) at 6-month
follow-up, conducted by an independent clinician. The
Working Alliance Inventory was administered after
session 3. Therapy compliance was assessed in terms
of the percentage of online session tasks and homework
assignments completed.
Results: The findings of the study will be presented,
with a focus on the potential moderating effects of child
age. It will also examine the meditational role of therapy
compliance in explaining the impact of child and family
factors upon therapy outcome.
Conclusions: Information about predictor variables will
enable better targeting of online CBT interventions to
those young people who are most likely to achieve positive
treatment outcomes
The effectiveness of casebased CBT treatment
for children with anxiety disorders, who show
minimal or no improvement to manual based
treatment
Irene Lundkvist-Houndoumadi1; Mikael Thastum1
1
Aarhus University, Denmark
Background: The Cool Kids Program has been
extensively evaluated in controlled trials and results
demonstrate that up to 80% of children, who complete
the program, are markedly improved (e.g. Hudson,
Rapee, et.al. 2009). Nevertheless, we still lack sufficient
knowledge, concerning children who do not respond to
treatment, and how they can be reached effectively. A
Randomised Controlled Trial is in progress at the Anxiety
clinic of Aarhus University and the present investigation
targets the individual non-responders in this trial.
Objective: To assess the effectiveness of an individualised
treatment plan for children, who three months after the
end of the Cool Kids/Chilled Adolescents Program show
little or no clinically meaningful reduction of symptoms
(measured by the Clinical Global Impression-Improvement
of Anxiety scale). It is hypothesised that anxiety symptoms
will decrease and will no longer interfere in personal and
family life, while changes in self-efficacy will occur during
and following treatment.
Method: The effectiveness of the individualised treatment
is explored through systematic case studies and evaluated
(pre-, post-treatment) on the basis of clinicians’ ratings
on diagnostic interviews (ADIS-IV-C/P) and Children’s
Global Assessment Scale, as well as self-report measures
completed by children and parents that reveal whether
statistically and clinically significant change occurred in
anxiety levels (Spence Children’s Anxiety Scale) and life
interference (Children’s Anxiety Life Inference Scale).
Self-efficacy will be assessed on every session, as well
as after the end of treatment (Self-efficacy Questionnaire
for Children).
Results: Preliminary results on the effectiveness of
the individualised treatment for non-responders will be
presented.
Discussion: Findings will be discussed in relation to
factors contributing to non-response to the manual based
treatment.
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EABCT 2012
S51-01
The role of internal sensations in the fear
network: Interoceptive awareness and attentional
bias in fear of flying
Anouk Vanden Bogaerde1; Rudi de Raedt1
1
Ghent University, Belgium
Introduction: Lang (1984) argues that an emotion
is stored as an information structure in memory in
three categories: stimulus representations (perceptual
information), meaning representations (declarative and
semantic knowledge) and response representations
(physiological/behavioral responses). Because of the
associative connections, the network as a whole can be
activated by input that only matches a few concepts within
the network. Research into fear and anxiety has mostly
focused on stimulus and meaning respresentations
showing attentional an interpretation biases of threatening
material in anxiety. Physiology and bodily sensations,
however, have largely been seen as simply bodily
correlates of fear. However, previous research of our lab
into flight phobia has shown a substantial role of bodily
sensations in this phobia (Vanden Bogaerde, Pieters and
De Raedt, 2011; Vanden Bogaerde, Derom and De Raedt,
in press). Furthermore, Lang (1984) proposed that the
response representations within the fear network have
the most strength in activating the entire fear network. So
subjects who show an enhanced interoceptive awareness,
or selective attention towards bodily sensations, should
have a lower threshold in activating response propositions
and by consequence the entire fear network.
Objectives: The hypothesis is that in individuals with
high interoceptive awareness, stimulus representations
would become more easily be activated, which would be
reflected in an attentional bias towards visual threat cues.
Method: For this purpose, a sample of flight anxious
individuals and controls completed a spatial cueing
task (Posner, 1980) with neutral versus flight-related
threatening pictures, next to a heartbeat detection task
designed to measure interoceptive awareness. Results:
The results are to be presented during the symposium.
Discussion: This study adds to the understanding of
the role of internal sensations in the development and
maintenance of anxiety.
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51
Therapist Supported Bibliotherapy for Anxious
Rural Children: Predictors of Treatment Outcome
Heidi J. Lyneham1; Sophie C. Schneider1; Jennifer L.
Hudson1; Ronald. M. Rapee1
1
Macquarie University, Sydney, Australia
Introduction: Prior research has indicated that anxiety
disorders in childhood can be successfully treated using
supported bibliotherapy. In particular using telephone
sessions to support a parent who worked with their own
child resulted in favourable outcomes for the majority of
children (Lyneham & Rapee, 2006). An initial indicator of
poor outcome was the inability of the parent and child to
work together on bibliotherapy materials. Other predictors
of outcome have yet to be established for this approach.
Objectives: The current study examined the possibility of
completing telephone sessions with children in addition to
working with parents to see if this lead to lower treatment
attrition and better treatment outcomes when compared to
the parent only approach. In addition predictors of outcome
examined in face-to-face treatment were measured to
establish their role during supported bibliotherapy.
Methodology: Rural children (aged 8-13, n=143) with a
principal diagnosis of an anxiety disorder were randomly
allocated to a parent only or a parent + child contact
condition. The parent only condition mimicked that used
in the previous study with the parent taking responsibility
for implementing treatment with their child. In the parent
+ child condition, the child self-help materials are
completed by the child under the guidance of the therapist
on the telephone in addition to the parent participating
in telephone sessions. Attrition rates, diagnostic change
and self-report questionnaires have been assessed post
treatment and after 6 months.
Results: Initial analyses have indicated that the addition
of children to the telephone sessions did not result in a
significant difference in outcomes compared to the parentonly approach. Outcome and attrition predictors are
similar to those found in traditional face-to-face therapy.
Conclusion: Supported bibliotherapy is an appropriate
option for families who are geographically isolated.
Assessment of predictors prior to treatment has potential
to funnel families into the most appropriate service.
Symposium 51 - Self focused attention in
anxiety and depression
Symposium
S50-04
Symposium
51
S51-02
S51-03
The role that self-distancing plays in enabling
adaptive self-reflection
Ehtan Kross1; Ozlem Ayduk2
1
University of Michigan, USA; 2University of California,
Berkeley, USA
Introduction: Few issues have aroused as much debate
in the clinical and social-cognitive literatures over the
past two decades as the role that self-reflection plays in
facilitating vs. undermining peoples’ capacity to cope
with negative experiences. While many studies indicate
that it is helpful for people to understand their negative
feelings (Pennebaker & Chung, 2007; Resick & Schnicke,
1992; Stanton, Kirk, Cameron, & Danoff-Burg, 2000;
Wilson & Gilbert, 2008), others show that attempts to do
this often backfire leading to rumination and worry (e.g.,
Nolen-Hoeksema, Wisco & Lyubomirsky, 2008; Watkins,
2009). Recently, a growing body of research has begun
to examine the psychological processes that distinguish
between adaptive versus maladaptive forms of selfreflection to shed light on these seemingly contradictory
sets of findings. According to one program of research
that has addressed this issue, we have suggested that selfdistancing plays a key role in enabling people to reflect
over negative experience adaptively (for review, see &
Kross & Ayduk, 2011).
Objectives: We begin this talk by reviewing select
findings from this program of research that support this
assumption in the context of reflecting over anger- and
depression-related experiences. We will then present new
research that has begun to explore the implications of selfdistancing for buffering people against anxiety and worry
surrounding social evaluative threat.
Results: Specifically, we will review findings from a
recent study, which indicated that cueing individuals to
reason over the anxiety they experience prior to delivering
a public speech from a self-distanced perspective
(compared to a self-immersed perspective) led them to
give more persuasive speeches.
Discussion: The discussion will focus on the basic
science and practical implications of these findings.
Alternating internal and external attention during
rest
Igor Marchetti1; Ernst HW Koster1
1
Ghent University, Belgium
Introduction: Many forms of psychopathology are linked
to an imbalance between internal and external attentional
focus with emotional disorders being characterized by
heightened internal focus of attention. Self-focus (SF) is
defined both as a stable trait and a transient state. With
regard to the latter condition, rest might be a potentially
informative context in which to investigate (neuro)
psychological correlates of temporary SF. First, we spend
a noticeable part of our life being not engaged in a task,
that is rest. Second, during rest a specific neural network,
termed Default Mode Network (DMN) is known to be
highly active. Third, the DMN is increasingly associated
both in clinical and non-clinical samples with different
types of SF.
Objectives: This study aims at investigating whether
intermittent internal and external attentional focus during
rest may contribute to temporary SF. We propose that
high levels of internal attention and low levels of external
attention are associated with heightened SF.
Method: Sixty-eight individuals, either dysphoric
or euthymic, were recruited. Participants were then
required to rest for about 25 minutes, keeping their
eyes closed and avoiding structured thinking. During
such period thoughts probes were administered, asking
to rate both internally-oriented and externally-oriented
attention on two 7-point Likert scales. Internallyoriented attention referred to all environmental stimuliindependent thought. Externally-oriented attention was
defined as the perceptions of environmental sensory
stimuli. Before and after the period of rest, mood- and
SF-related measures were collected. At the end of the
experiment, questionnaires about individual differences
were administered.
Results: The results will be presented during the
symposium.
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EABCT 2012
EABCT 2012
S52-01
Self-referential processing and negative
affectivity
Philippe Fossati1
1
Groupe Hospitalier Pitié Salpétrière, University Pierre &
Marie Curie, France
Self-regulation is an essential component of emotional
regulation. Emotional dysregulation related to impaired
self-processing has been proposed to be at the core
of Major Depressive disorders (MDD). Depression is
associated with Increased self-focus the tendency to
excessively engage in self-referential processing that is
to appraise stimuli as strongly related to oneself. Selfreferential processing relies mainly on cortical midline
structures, including the medial prefrontal cortex (MPFC).
Our team found an aberrant activation of the MPFC in
depressed patients (Lemogne et al., 2009). This abnormal
MPFC activation was stable over the course of depression
after 8 weeks of antidepressant treatment (Lemogne et
al., 2010) suggesting that impaired MPFC activation may
represent a vulnerability marker for depression. In this
talk we will present data that test this hypothesis. We have
examined the effects of the 5-HTTLPR polymorphism,
personality traits and recent life-stress on brain activity
induced by several self-referential tasks. We will show
that both genetic risks and personality traits affected
the activation of MPFC and amygdala during self tasks.
Moreover we will discuss the role of different components
of rumination on the ability to engage in analytical versus
experiential self-focus. Overall we will show that selfprocessing may maintain negative mood and reinforce the
experience of negative emotion of depressed patients and
healthy subjects.
S52-02
Emotion specific attentional bias in depression
from a cognitive neuroscience perspective
Rudi de Raedt1
1
Ghent University, Belgium
Although there are currently well-established cognitivebehavioral and somatic treatment options for depression,
relapse or recurrence after remission or recovery remains
high. This indicates that current treatment options might
be insufficiently successful in identifying and diminishing
underlying vulnerability. Interestingly, although many affective
disorders share similar neurobiological and cognitive
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52
Training to Link Executive Control and Emotion
– A training procedure to reduce rumination and
increase reappraisal
Nilly Mor1
1
The Hebrew University of Jerusalem, Israel
Introduction: Self-focus when in a bad mood can be
helpful or not depending on the form it takes. Whereas
rumination can lead to depression and anxiety, reappraisal
of situations that elicit negative mood is associated
with improved well-being (Nolen-Hoeksema, Wisco &
Lyubomirsky, 2008). Executive control, the ability to
control attention, has been shown to attenuate emotional
responses (Cohen et al., 2011) and is thought to affect
both rumination and reappraisal (Cohen et al., in
press). Ruminators show poor control and reappraisers
demonstrate good executive control.
Objectives: In the current study, we examined whether
training people to exhibit executive control when
processing negative emotional content, would lead to
reduced rumination and increased reappraisal, as well as
to reduction in negative affect.
Method: Executive control was trained using an
emotional-flanker task consisting of congruent and
incongruent targets, followed by a presentation of a
neutral or negative pictorial stimulus. Incongruent targets
recruit executive control processes and inhibit emotional
responses. Participants were assigned to either a high or
a low control group. In the high-control condition 80%
of the incongruent trials were followed by a negative
stimulus. In the low-control condition this was only the
case in 20% of the incongruent trials. State rumination
and reappraisal were subsequently assessed. In addition,
the effect of the training on negative mood and on reactivity
to emotional stimuli, were examined. Participants also
completed measures of depression and anxiety and
habitual rumination and reappraisal tendencies.
Results: The results are to be presented during the
symposium.
Discussion: This study can assist in forming better
therapeutic interventions for individuals suffering from
anxiety and depression by understanding the cognitive
underpinnings of maladaptive coping strategies such
as rumination or difficulty to use reappraisal in daily life
situations.
Symposium 52 - Emotion processing in
depression
Symposium
S51-04
Symposium
52
features related to general emotion regulation, depression
is characterized by a specific attentional bias at later stages
of information processing, which fits with depression
specific biological (e.g. dorsolateral prefrontal cortex cortex
hypoactivation) and cognitive (e.g. rumination) markers of
vulnerability. We tested a framework to understand increases in
vulnerability for depression after recurrent episodes that links
attention processes and schema-activation to negative mood
states, by integrating cognitive and neurobiological findings.
The basic idea of our framework is that decreased activity
in prefrontal areas, mediated by the serotonin metabolism
which is under control of the HPA axis, is associated with
an impaired attenuation of subcortical regions, resulting in
prolonged activation of the amygdala in response to stressors
in the environment. Reduced prefrontal control in interaction
with depressogenic schemas leads to impaired ability to
exert attentional inhibitory control over negative elaborative
processes such as rumination, leading to sustained
negative affect. These elaborative processes are triggered
by the activation of negative schemas after confrontation
with stressors. Our research revealed that emotion specific
attentional impairments might be the underlying process to
explain the increasing vulnerability after depressive episodes,
linking cognitive and biological factors. The aim of our work
is to stimulate translational research, promoting research on
the use of cognitive training combined with cognitive behavior
therapy to reduce relapse.
S52-03
Modulation of emotion processing by
serotonergic and noradrenergic antidepressants
Annette Bruehl1; Lutz Jäncke2; Uwe Herwig1
1
University Hospital of Psychiatry, Zurich, Switzerland;
2
University of Zurich, Switzerland
Most antidepressants act by modulating serotonergic
and noradrenergic pathways. However, the effects of
antidepressants on brain networks involved in emotion
processing are not yet completely understood. We
examined the effects of a single dose of a noradrenergic
and a serotonergic reuptake inhibitor on brain activity
during the anticipation and perception of emotional stimuli
using functional magnetic resonance imaging (fMRI) in
healthy subjects. The emotional anticipation paradigm has
previously been shown to activate depression-associated
brain regions in healthy subjects and in depressed patients.
The acute application of the respective reuptake inhibitor
was meant to increase the respective neurotransmission,
which could identify those regions activated by the paradigm
and differentially modulated by the two antidepressants.
Main differences between the two modulatory mechanisms
were a focus of noradrenergic modulation by reboxetine in
increased activity in the thalamus during the anticipation
126
and perception of negative stimuli, whereas citalopram as
serotonergic reuptake inhibitor acted more prominently on
prefrontal and insular regions. These regions differentially
identified by an acute pharmacological intervention are
supposedly also regions in which adaptations in the
development of an antidepressant effect occur. Therefore,
the differentiation of brain circuits involved in depression
regarding noradrenergic of serotonergic modulation could
provide predictive information on the treatment response
to specific antidepressants in depression.
S52-04
Causal attribution – one example of
dysfunctional emotion regulation in depression
Eva-Maria Seidel1
1
University of Vienna, Austria
Introduction: The perceived cause of an event has the
capacity to modulate emotional reactions. Depressed
patients show a so-called non self-serving bias, attributing
negative events internally but positive events externally.
Such cognitive biases are thought to play a critical role in
the pathogenesis and maintenance of depression.
Methods: In an fMRI study, depressed patients and
controls were confronted with positive and negative social
events and made causal attributions (internal vs. external).
Results: Controls showed a pronounced self-serving bias,
whereas patients demonstrated a balanced attributional
pattern. Self-serving attributions were positively correlated
with self-esteem in controls. In patients symptom severity
was negatively correlated with self-serving attributions.
Imaging data revealed greater activation in a frontotemporal network associated with non self-serving
attributions in controls but self-serving attributions in
patients. Moreover, in controls, the percentage of selfserving attributions was associated with greater amygdala
activation during non self-serving attributions whereas
patients demonstrated the opposite effect. In addition,
in controls we observed stronger coupling between
dorsomedial PFC and limbic regions during self-serving
attributions.
Conclusions: The association of the behaviorally less
frequent attributional pattern with activation in a frontotemporal network suggests that non self-serving responses
produce a self-related response conflict in controls, while
self-serving responses produce this conflict in patients.
This is bolstered by the divergent correlation of behavioral
data with neural activation seen in patients and controls.
Moreover, the coupling between the dorsomedial PFC and
limbic regions present in controls was lost in patients
which may relate to aberrant emotion regulation. Future
studies should investigate the effects of cognitive therapy
on these neural mechanisms.
EABCT 2012
Understanding and reducing relapse rates in the
treatment of trichotillomania and pathological
skin picking
Ger Keijsers1; Joyce Maas1; Kathrin Schuck1
1
Radboud University, The Netherlands
Introduction: Habit disorders such as trichotillomania
(TTM) and pathological skin picking (PSP) are classified
(DSM-IV) as impulse-control disorders. The results of
behaviour therapy for these habit disorders tend to be
excellent on the short-term, but follow-up studies show
relapse rates as high as 70%, two years after treatment
completion.
Objectives: The present paper discusses the findings
of several studies in which we investigated ways of
understanding and reducing these high relapse rates.
Methodology: A randomized controlled trial into the
(short- and long term) effects of behaviour therapy versus
cognitive therapy for TTM; a randomized, waiting-list
controlled trial into the effects of cognitive-behaviour
therapy in PSP.
Results: First, we present data on the development of an
11-item instrument to measure self-control cognitions.
Then we show that the long term treatment effects of
pure behaviour therapy due to its reliance on (effortful)
self-control, could not be exceeded by the effects pure
cognitive therapy. We further show data on implicit action
tendencies in patients suffering from PSP and their
relationship to treatment outcome.
Discussion and Conclusion: Implicit action tendencies
in habit disorders may contribute to high relapse rates in
habit disorders.
S53-02
Attentional Avoidance from Hair-related Cues
among Individuals with Trichotillomania
Douglas W. Woods1; Han-Joo Lee1; Shana A. Franklin1;
Jennifer E. Turkel1; Amy R. Goetz1
1
University of Wisconsin-Milwaukee, USA
Introduction: Over the past decade, there has been a
significant growth in clinical research on trichotillomania
(TTM). However, there has been very little research with
regard to the nature of cognitive processes underlying TTM.
Objectives: This presentation tests whether individuals with
TTM exhibit biased attentional processing towards hair cues.
EABCT 2012
S53-03
Implicit processes in snack-eating behaviour
Joyce Maas1; Ger P.J. Keijsers1; Jason Sharbanee2; Mike
Rinck1; Eni S. Becker1
1
Radboud University, The Netherlands; 2The University of
Western Australia, Australia
Introduction: Dual process models (e.g. Chaiken,
Liberman, & Eagly, 1989; Norman & Shallice, 1986; Petty
& Cacioppo; Strack & Deutsch, 2004) differentiate between
two separate but interacting systems: one more explicit,
deliberate system and one more implicit, automatic
system. Especially in the case of unwanted habits, this
implicit system seems important, since unwanted habits
occur automatically and are guided by implicit processes.
Objectives and Methodology: The present study will
focus on two different implicit processes in snack-eating
behaviour: automatic action tendencies (approaching
versus avoiding food) and two categories of automatic
evaluations (evaluations related to self-esteem and
evaluations related to taste/liking of the food).We
conducted a study in which we compared participants who
were bothered by their habit of eating snacks to participants
with another unwanted habit.
Results: With regard to the Approach Avoidance Task
snack-eating participants showed impaired avoidance
towards all food stimuli. With regard to the Affective
Priming Task, snack-eating participants showed a weaker
association between positive self-esteem targets and food
in general than the control group. The groups did not differ
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S53-01
Methodology: We compared 13 individuals with TTM
to 20 non-clinical individuals without TTM, using an
exogenous cueing task, one of the most widely used
attentional bias measures in the field. In this task, we
presented hair cues, general threat cues, and neutral cues
at three varying stimulus durations (i.e., 250 ms, 500
ms, and 1500 ms) to examine the pattern of attentional
processing toward each type of cue.
Results: Results revealed that individuals with TTM
showed increased attentional avoidance from hair cues
at later stages of attentional processing (i.e., 1500 ms),
but no attentional bias was observed at earlier stages of
processing (i.e., 250 ms and 500 ms). Importantly, the
magnitude of attentional avoidance from hair cues was
significantly associated with severity of TTM symptoms,
but not with the level of general depression and anxiety.
Discussion: These findings suggest that TTM is
characterized by attentional avoidance from hair cues,
which may reflect the individual’s effort to down-regulate
negative emotions associated with the pulling-related
cues. The theoretical and clinical implications of these
findings will be discussed.
Symposium
Symposium 53 - Fundamental processes in
unwanted habits and impulse control
disorders
with respect to taste targets. Snack eating participants
did also not differ from the control group with respect to
explicit taste ratings.
Discussion and conclusion: These results are in line
with Berridge’s (1996) neurocognitive model, which states
that ‘wanting’, reflected by the automatic action tendencies
in this study, seems to be more important in explaining
problematic snack-eating behaviour than ‘liking’, reflected
by the (automatic) evaluations in this study. Although
wanting and liking go together most of the time – food is
liked and therefore approached – when eating becomes
an unwanted habit and people become addicted to food,
wanting and liking may diverge.
S53-04
Symposium
53
Triple A: Automatic Approach Avoidance of
smoking-related cues in smokers, cravers, exsmokers and non-smokers
Marcella L. Woud1; Joyce Maas1; Reinout W. Wiers2; Eni
S. Becker1; Mike Rinck1
1
Radboud University, The Netherlands; 2University of
Amsterdam, The Netherlands
Introduction: According to theories of addiction, approach
biases towards smoking-related cues play a central role in
nicotine dependence. Such biases are not only supposed
to maintain the addiction but are also crucial when it
comes to relapse. Several studies investigated the role
of approach biases in nicotine dependence and a variety
of paradigms have been employed. However, results
are highly inconsistent and difficult to compare. Hence,
what is clearly missing from the literature is a structural
comparison of measures of approach-avoidance.
Objectives and Methodology: The present study
aims to fill this gap. Therefore, 3 different measures of
approach-avoidance were employed, namely an Approach
Avoidance Task (AAT), a Stimulus Response Compatibility
Task (SRC), and a Single Target Implicit Association
Test (ST-IAT) involving approach-avoidance attributes.
Moreover, the smoking Stroop was used and explicit
attitudes towards smoking were assessed. This test battery
was applied to smokers, cravers, ex-smokers and nonsmokers.
Results: The general result pattern did not reveal
strong approach biases towards smoking-related cues.
Regarding the ST-IAT, analyses revealed that cravers had
stronger approach associations towards smoking-related
cues, whereas non-smokers had stronger avoidance
associations. No differences in approach-avoidance
associations were found in smokers and ex-smokers. The
outcome of the AAT and SRC, however, is less straight
forward.
Discussion and Conclusion: Overall, not all measures
128
of approach-avoidance provided clear cut evidence of
approach biases towards smoking-related cues. Hence, the
present results will be critically discussed with reference
to predictions of theories of addiction.
S53-05
Emotion regulation model and body-focused
repetitive behaviours: An experimental study
Kieron O’Connor1; Sarah Roberts1
1
Montreal University, Canada
Introduction: Body-focused repetitive behaviours
(BRFBs) include trichotillomania, skin-picking, and nailbiting. A growing body of research has provided support
for an emotion regulation model for BFRBs. This model
proposes that individuals with BFRBs have difficulty
regulating certain emotions, and engage in repetitive
behaviours to decrease negative affect. Results from the few
BFRB studies that manipulated emotions in experimental
conditions suggest that certain affective states are more
likely to provoke BFRB than others. Individuals with BFRBs
tend to engage in their habit during sedentary activities
(e.g., reading, studying), frustrating activities, or activities
or situations appraised as inactive or boring.
Objectives and Methodology: The study described here
measured BFRB in experimental conditions and tested two
hypotheses: 1) that individuals with BFRBs would engage
in their habit more often in situations that elicit boredom,
frustration, and that 2) individuals with BFRBs would
have deficits in overall emotion regulation. Participants
with BFRBs and control participants were individually
guided through experimental conditions designed to elicit
boredom or frustration, stress, and calm, respectively.
Participants completed a measure of subjective emotion
after each condition, allowing a validity check of the
experimental conditions. Participants were filmed in each
condition. Trained raters scored the DVD recordings for
BFRBs to determine which condition induced the most
body-focused behaviour.
Results: Results suggest that individuals with BFRBs
have difficulty identifying how they are feeling and
difficulty in controlling their behaviour in the presence of
some negative emotions. Discussion and Conclusion:
Individuals with BFRBs seem to have difficulty with
identifying their own emotions. The repetitive behaviours
seem to have the function to decrease negative affect.
EABCT 2012
Critical Components and Processes Involved in
the CBT of Panic Disorder with Agoraphobia
Andrew Gloster1; Jens Klotsche1; Michael Höfller1;
Franziska Einsle1; Hans-Ulrich Wittchen1
1
Technische Universität Dresden, Germany
A refined understanding of the mechanisms of action at
work in therapy that inform improvements in treatment
is one of the largest challenges facing the field of
psychotherapy. Towards this end, the Mechanisms
of Action in CBT (MAC) RCT for Panic Disorder with
Agoraphobia (PD/AG) was initiated. In this multicenter
study, n=301 active treatment and n=68 WL patients were
treated. This presentation examines possible mechanisms
of action via two strategies. First, a component analysis is
conducted on the hypothesized critical treatment element
of exposure. Results show a dose response relationship
between the reduction in avoidance and the amount
of exposure undertaken by patients. Second, multiple
mediational analyses are employed to examine the role
of hypothesized processes for the outcomes of panic
symptoms and general functioning. Panic symptoms were
partially mediated by agoraphobic cognitions, agoraphobic
avoidance, and anxiety sensitivity. In contrast, general
functioning was partially mediated only by agoraphobic
avoidance and psychological flexibility. Results will be
presented that document differential processes across
the different stages of treatment (i.e., psychoeducation
and exposure in situ) and through the 6-month follow-up.
Taken together, these results point to the importance of
patients engaging in exposure, suggest which processes
are involved in reaping the benefits of exposure, and
begin to offer clues on how to intervene with subgroups
of patients.
EABCT 2012
Dynamics of defensive reactivity in patients with
panic disorder and agoraphobia: Implications for
the etiology and exposure based psychotherapy
of panic disorder
Jan Richter1; Alfons O. Hamm1
1
University of Greifswald, Germany
Learning theory of panic disorder distinguished between
acute panic and anxious apprehension as distinct
emotional states. Following animal models these clinical
entities reflect different stages of defensive reactivity
depending upon the imminence of threat.To test this model
we investigated the defensive reactivity of 345 patients
with panic disorder and agoraphobia prior to a multicenter
controlled clinical trial in which patients were randomized
to a wait-list control group or to one of two manual-based
CBT variants (with (T+) vs. without (T-) accompaniment
by the therapist during exposure). During a standardized
behavioral avoidance test (being entrapped in a small,
dark chamber) defensive reactivity was assed measuring
avoidance and escape behavior, self-reports of anxiety and
panic symptoms, autonomic arousal (heart rate and skin
conductance level), and potentiation of the startle reflex.
Patients differed substantially in their defensive reactivity.
While 31.6% of the patients showed strong anxious
apprehension during the task (increased reports of anxiety,
elevated physiological arousal and startle potentiation),
20.9% of the patients escaped from the chamber. Active
escape was initiated at the peak of the autonomic surge
accompanied by an inhibited startle response as predicted
by the animal model. These physiological responses
resembled the pattern observed during 34 reported panic
attacks. Importantly, therapy outcome varied depending on
defensive stage. While escaping patients improved more
than task completing patients during treatment condition
T+, avoiding patients did less (11.3%). Defensive reactivity
in the patients seems to be dynamically organized ranging
from anxious apprehension to panic. Patients showing
panic associated behavior during the task (i.e. flight
behavior combined with strong autonomic arousal) are
particularly predisposed for exposure based therapy.
Implications for the understanding of mechanisms of
action of CBT were discussed.
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S54-01
S54-02
Symposium
Symposium 54 - Towards a Better
Understanding of the Mechanisms of CBT:
Results from RCT’s on Anxiety Disorders
S54-03
S54-04
Predicting outcome in CBT for social phobia:
Results from a large multicenter trial
Juergen Hoyer1; Wolfgang Hiller2; Ulrich Stangier3; Ulrike
Willutzki4; Jörg Wiltink5; Eric Leibing6
1
Technical University Dresden, Germany; 2Johannes
Gutenberg University Mainz, Germany; 3Goethe University
Frankfurt, Germany; 4Ruhr-University Bochum, Germany;
5
University of Mainz, Germany; 6Georg-August-University
Goettingen, Germany
The relationship between competence,
adherence and outcome in cognitive therapy for
social phobia
Denise M. Ginzburg1; Volkmar Höfling1; Christiane
Bohn1;Florian Weck1; David M. Clark2; Ulrich Stangier1
1
Goethe University, Frankfurt, Germany; 2University of
Oxford, United Kingdom
Symposium
54
Prediction of outcome in CBT for social phobia has
been unsatisfying. The low explanatory power of
hitherto examined patient characteristics may be due to
methodological weaknesses of previous studies (e.g.,
small sample size, neglect of important psychological
variables). In this study, we examined possible predictors
of outcome for CBT in social phobia based on a relatively
large patient sample and we integrated a number of
theoretically relevant patient characteristics that have not
yet been examined as potential predictors for treatment
outcome. Specifically, we expected that low self-esteem
and interpersonal problems would predict less favorable
outcomes even after controlling for socio-demographic
variables, symptom severity, and depression.
Data were taken from the CBT arm of a large multi-center
comparative psychotherapy study. N = 244 patients fulfilling
DSM-IV criteria for SAD were included. Therapies were
conducted by N = 55 therapists under close supervision
according to the CBT manual for social phobia by Clark
and Wells. Severity of SAD was assessed at baseline and
at the end of treatment with the Liebowitz-Social-AnxietyScale (LSAS). Predictors of symptom reduction included a
broad set of demographic and disorder-related variables,
and self-evaluative, interpersonal and process variables.
Multiple regression analyses were applied.
Preliminary results show that more than 50% of the posttreatment variance could be explained by the significant
predictors: symptom severity (LSAS score at treatment
start), self-esteem, depression, and interpersonal
problems (especially an autocratic interpersonal style).
The encouraging results indicate that probabilities
for treatment success (or failure) can be meaningfully
predicted. Based on our data, ideas for combining
patient-oriented, adaptive strategies and manualized
treatment procedures are put forward.
130
Research on the relationship between the competence with
which cognitive-behavior therapy (CBT) is delivered and
the outcomes that patients achieve is required to inform
the content of training programs. Several studies have
demonstrated a positive relationship between competence
and outcome on CBT for depression but studies of CBT for
anxiety disorders are lacking. The present study aims to
fill the gap by analysing the relationship between therapy
competence and patient outcome in cognitive therapy
(CT) for social anxiety disorder. A secondary aim was to
determine whether a measure of therapy adherence would
also predict outcome. Data were drawn from a randomized
controlled, multicenter trial. Five trained raters evaluated
videotapes of two therapy sessions per patient using the
Cognitive Therapy Competence Scale for Social Phobia
(CTCS-SP) and the Cognitive Therapy Adherence Scale for
Social Phobia (CTAS-SP). Inter-rater reliability was high.
Patient outcome was assessed by different, independent
raters using the Clinical Global Impression Improvement
Scale (CGI-I). Results indicated that therapy competence
significantly predicted patient outcome (r = .68). Therapy
adherence also predicted outcome but accounted for
much less of the variance (46% versus 11%). Neither
competence nor adherence was significantly related to
the age, gender, or the general clinical experience of the
therapists. More experience with the specific treatment was
associated with higher adherence. The findings support
the view that competence influences outcome and should
be one of the foci of training programs. Further research is
needed to understand the complex relationships between
competence and other therapy factors that are likely to
influence outcome with CBT for anxiety.
EABCT 2012
While the knowlegde on specific active ingredients in the
cognitive behavioural treatment of social phobia is constantly
growing, there is evidence that treatments are often delivered
suboptimally. Research on the link between treatment
integrity and therapy outcome can help to bridge this gap
between science and practice. Findings on the relationship
between treatment integrity and therapy outcome are
inconsistent, however, treatment modality, type of disorder,
and assessment procedures may explain inconsistencies.
By considering recent research recommendations regarding
the establishment and assessment of treatment integrity the
present study aims to further explore how adherence and
competence relate to outcome in the cognitive treatment of
social phobia. A random sample of 218 videotapes of cognitive
therapy sessions from the cognitive treatments of 117 patients
delivered by 51 therapists was selected from a randomized
controlled, multicenter trial and rated by seven in dependent
and trained observers using two rating scales: the Cognitive
Therapy Adherence (CTAS-SP) and the Competence Scale for
Social Phobia (CTCS-SP). Patient outcome was assessed by
independent raters, using the Liebowitz Social Anxiety Scale.
Results indicated that competence correlated significantly
with outcome (r = .24), whereas adherence was unrelated to
outcome (r= .02). Prediction of outcome by competence and
adherence was computed using HLM with therapist as within
level. Although differences between therapists had a significant
effect, competence, but not adherence, was still found to
significantly predict outcome. The current results suggest
that although adherence is required to draw valid conclusions
about the efficacy of treatment in clinical trials, competence
is more relevant in delivering efficacious treatments. Further
research is needed to clarify the determinants and the
development of therapist competence.
S55-01
Poor affect recognition and regulation in
personality disorders: preliminary data from an
outpatient sample of treatment-seeking adults
Giancarlo Dimaggio1; Giampaolo Salvatore1; Antonella
Montano1; Paul H. Lysaker1; Luisa Buonocore1; Silvia
Carlucci1; Nadia Disturco1; Lorena Bianchi1; Francesca
Santini1; Elzbieta Baca1; Vivia Galasso1; Francesca
Carabelli1; Paolo Ottavi1; Giovanna Attinà1; Dario
Catania1; Maddalena D’Urzo1; Antonella Imbimbo1;
Roberta Borzì1; Raffaele Popolo1
1
Centro di Terapia Metacognitiva Interpersonale, Rome,
Italy
Patients with personality disorders feature an array of
difficulties in recognizing their own affects, the affects of
others and using awareness of emotion to regulate them
in an effective way. Some patients are emotional unaware
and display either emotional inhibition of emotional
dysregulations and in some cases both problems are
present. In this study we investigate problems in 1)
awareness of own affects (Bermond-Vorst alexithymia
questionnaire); 2) awareness of the affects of others and
of the role of affects in social interactions (Meyer Salovey
Caruso Emotional Intelligence Test); 3) tendency to inhibit
own affects (Emotional Inhibition Scale); 4) Emotional
dysregulation (Difficulties in Emotion Regulation Scale).
Correlates of poor awareness and regulation of affects with
personality disorders and symptoms are presented.
S55-02
Reconceptualising recovery style: correlations
with symptoms and functioning of integration,
sealing over and ruminative preoccupation in a
sample of adults with severe mental illness
Angus MacBeth1; Andrew Gumley1; Laura Mitchell1;
Elizabeth Reilly1; Giancarlo Dimaggio2; Paul Lysaker3;
Heather Laithwaite1; Kate M Davidson1
1
University of Glasgow, United Kingdom; 2Centre for
Metacognitive Interpersonal Therapy, Rome, Italy;
3
Indiana University School of Medicine, Bloomington, USA
The ability to regulate affect in the face of stress has
implications for recovery and chronicity in complex mental
health problems such as schizophrenia and borderline
personality disorder. In addition to adaptive integrating
EABCT 2012
131
55
The role of therapist competence and adherence
in predicting outcome in cognitive therapy of
social phobia: Results from the SOPHO-NET –a
research network on psychoterapy for social
phobia
Katrin von Consbruch1; Volkmar Höfling1; David M.
Clark2; Sarah-Maria Werner1; Denise Ginzburg1; Ulrich
Stangier1
1
Goethe University Frankfurt, Germany; 2University of
Oxford, United Kindgdom
Symposium 55 - Mental state
understanding dysfunctions in
psychosis and personality disorders
Symposium
S54-05
Symposium
55
and maladaptive sealing over recovery styles it may be
possible to delineate a further maladaptive recovery style
of “ruminative preoccupation”. In addition, the capacity to
compassionately relate to self and others may be linked to
recovery trajectories. Here we present data on the utility
of a Narrative Compassion Scale for recovery in a mixed
clinical sample of individuals with diagnoses of psychotic
disorder (with or without interpersonal violence) and
Borderline Personality Disorder
Design: A cross-sectional mixed methods design was
used with a within subjects condition and three between
subjects groups
Methods: Forty-Three individuals were interviewed and
transcripts coded with the Narrative Compassion Scale
(NCS) and metacognitive assessment scale (MAS). The
NCS permits coding of recovery and compassion. Selfreport measures of compassion, attachment anxiety/
avoidance and psychiatric symptoms were also completed.
Results: Three recovery styles were identified. Sealing over and
Ruminatively Preoccupied styles were negatively associated
with Integration. Sealing over and Ruminative Preoccupation
were also negatively correlated. Differences between clinical
groups will be discussed. Recovery styles were associated
with clinical and attachment variables. Compassion was
strongly positively correlated with Integration; and negatively
correlated with Sealing Over. Findings for relationships with
the MAS will also be discussed.
Conclusions: The NCS is a promising narrative measure
of recovery and compassionate responding. Implications
are discussed in terms of a transdiagnostic understanding
of recovery processes.
S55-03
Reflective function as a modeator and mediator
for treatment outcomes in adolescent onset
psychosis following psychological therapy – a
structural equation modeling approach
Matthias Schwannauer1; Helen Griffiths1; Abbi Noble2;
Nicole Scherer-Dickson2
1
The University of Edinburgh, United Kingdom; 2CAMHS,
NHS Lothian, United Kingdom
In this paper we are going to present the development and
service application of CBT and IPT for adolescents with
adolescent onset psychosis. We know that positive service
engagement and engagement with psychological therapies
is a key aspect in the appropriate recognition and treatment
of adolescent onset psychosis. The under treatment of
adolescents presenting early with these difficulties can be
explained by a combination of limited access to and under
utilization of mental health care. From a developmental
psychopathology perspective we know that attachment
experiences play a key role in the individual’s ability to utilize
132
supports and to regulate affective states following significant
life events, such as past interpersonal trauma and the onset of
major mental health problems. Reflective function which in the
individual develops in the context of attachment experiences
and attachment mental states is hypothesized to be a key
indicator for treatment outcomes and recovery.
We recruited 86 young people with adolescent onset
psychosis and bipolar disorder and within a naturalistic
single blind treatment trial we randomized them to specific
psychological therapy and treatment as usual. We will
examine the effects of treatment on core symptoms, coping
styles and interpersonal problems. The results showed
clear improvement in core symptomatology and quality of
life for following intrevention. We will further demonstrate
the impact of reflective function on service engagement,
core treament effects and quality of life.
S55-04
Investigation of mentalizing abilities in
schizophrenia patients and implications for
future research and clinical application
Katja Koelkebeck1; Anya Pedersen1; Jochen Bauer1;
Patricia Ohrmann1; Jun Miyata2; Ryousaku Kawada2;
Kazuyuki Hirao2; Toshiya Murai2
1
University of Muenster, Germany; 2Kyoto University, Japan
Schizophrenia patients display poor mentalizing abilities
on a wide range of tasks devoted to the investigation of
social-interactive functions. Recent research focuses on
tasks that assess these abilities “online”, which means
more interactive, in contrast to older tasks that present
static cartoons or stories. In our previous studies, we
investigated mentalizing abilities using the “Moving
shapes” task developed by Uta Frith and colleagues in
samples of first-episode and chronic schizophrenia using
behavioral as well as functional brain imaging measures.
This task is known to employ “online” mentalizing
abilities. Using this task, we could show a stable deficit in
behavioral performance, but more importantly, we could
show a severe delay in brain activation in schizophrenia
patients during mentalizing performance. Additionally,
we could show that performance deficits were correlated
to grey matter reduction in patients. Thus, clinicalbehavioral performance deficits might be related to
brain dysfunction on the functional and structural level.
Cognitive remediation trainings should therefore take
into account time course of schizophrenia patient’s
performance on mentalizing tasks. Additionally, future
studies should concentrate on brain imaging methods to
evaluate cognitive remediation training methods to show
their efficacy on a neurobiological level. Results of recent
studies and implication for future research on cognitive
remediation trainings will be discussed.
EABCT 2012
Life-review intervention with computer
supplements for depression in the elderly: A
randomized controlled trial
Andreas Maercker1; Barbara Preschl1
1
University of Zurich, Switzerland
Background: The aim of this study was to investigate a
life-review intervention in a combined setting: a face-toface setting with additional computer use.
Methods: This study explored whether a six-weeks lifereview intervention with computer supplements of the
e-mental health “Butler-system” (Botella et al., 2009) was
an effective approach to reduce depressive symptoms
and other outcomes in older adults aged 65 and above.
The participants were randomized to a treatment group
or a waiting list control group. N= 20 in the intervention
group, and N= 16 in the control group completed postassessment, and 14 completed the follow-up assessment.
Main Results: Significant changes from pre- to posttreatment resulted for depression, well-being, self-esteem
and obsessive reminiscence. Depressive symptoms
decreased significantly over time until 3 months followup in the intervention group. Furthermore, the intervention
leads to an increase of well-being and a decrease of
obsessive reminiscence among the participants in the
intervention group from pre-treatment to follow-up with
effect sizes around d = .85.
Conclusion: By and large, the results indicate that the
life-review intervention in this combined e-mental health
setting could be recommended for older patients.
S56-02
Psychotherapy in old people’s homes –
Conception and evaluation
Anton-Rupert Laireiter1; Ralph Lenzenweger1; Ernestine
Krammer1;, Urs Baumann1; Randolf Messer2
1
University of Salzburg, Austria; 2Seniorenheime,
Magistrat Salzburg, Austria
Objectives: Due to general prolongation of life old people
need psychotherapy more often. The prevalence of mental
disorders in this group of people is about 15 to 20%
making psychotherapy to an important source of help in
this age-group. The authors are working with these people
since 1997 and have developed a specific therapeutic
approach on the basis of Cognitive Behavior Therapy to
treat psychological problems of people in residencyhomes.
EABCT 2012
S56-03
A comprehensive, CBT-based treatment
approach for individuals with mild Alzheimer’s
and their caregivers: A case study
Simon Forstmeier1; Andreas Maercker1; Egemen
Savaskan2; Tanja Roth2
1
University of Zurich, Switzerland; 2Psychiatric University
Hospital Zurich, Switzerland
Introduction: About 90% of all mild Alzheimer dementia
(AD) cases experience neuropsychiatric symptoms.
Although some research has supported the effectiveness
of specific psychotherapeutic approaches for mild AD,
there are only few attempts to evaluate a CBT-based, multicomponent treatment programme.
Objectives and Methodology: The CBTAC (CognitiveBehavioral Treatment for Mild Alzheimer’s Patients and
their Caregivers) study is a randomized controlled trial that
evaluates the effect of such a psychotherapy programme
on the health of patients with mild AD and their caregivers.
It consists of 25 weekly sessions, including eight modules:
diagnosis & goal setting; psychoeducation; engagement
in pleasant activities; cognitive restructuring; live review;
behavior management; interventions for the caregiver;
and couples counselling. The control condition receives
treatment as usual. Before and after the treatment phase,
participants will be assessed. Follow-ups take place at 6,
and 12 months post-treatment. A single case study will
be presented to illustrate the comprehensive treatment
approach. A multiple-baseline design was applied.
Primary outcome measure is depression, assessed by
the Geriatric Depression Scale and the Cornell Scale for
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56
S56-01
Methods: Therapies of about 100 seniors living in
residency homes, mean-age 87, suffering from depression,
anxiety and adjustment disorders, were evaluated
retrospectively and prospectively in an effectiveness study
using data from patients, therapists and nurses. Changes
in medication were evaluated by analyzing nursing
documentations.
Results: Therapies were effective, primarily from the
therapists‘ and nurses‘ point of view. In addition a
significant reduction in antidepressant, analgesic and
tranquilizer-medication was found. Prospective evaluation
of the therapies (pre to post-comparisons) support this
conclusion and show that these therapies are very effective
in reducing symptoms of psychological disorders (anxiety,
depression); they were less effective in somatic complaints
and interpersonal problems.
Conclusions: Psychotherapy can be offered easily and
effectively to very old people, also in residency homes.
Our experiences however show that progressive somatic
illness and dementia are limiting its outcomes.
Symposium
Symposium 56 - Psychotherapy in the
elderly
Depression in Dementia. Further instruments assess other
neuropsychiatric, functional and cognitive symptoms as
well as coping strategies of the patients, and depression,
anxiety, anger, general health and coping of the caregiver.
Results: Data collection is currently under way. The
results of the single case study to provide evidence of
benefit of the psychotherapeutic intervention will be
presented. Additionally, preliminary results of group level
analyses will be presented.
Discussion and Conclusion: Findings will be discussed
with respect to their conceptual, empirical, and clinical
implications. If emotional health of cognitive impaired
individuals could be effectively treated, the health care
costs could be reduced significantly.
S56-04
Symposium
56
One-year-follow-up of a randomized-controlled
telephone therapy for family caregivers of
persons with dementia
Gabriele Wilz1; Denise Schinkoethe1
1
University of Jena, Germany
Introduction: Meta-analyses indicate that interventions
for family caregivers of persons with dementia show
heterogeneous and moderate to low positive effects
and investigations of long-term effects are rare. Thus,
the development and long-term evaluation of adequate
and effective interventions is still needed to prevent
caregivers’ physical and mental illness. Therefore, in this
study we focused on the evaluation of long-term effects
of a cognitive-behavioral (CBT) telephone intervention
adapted to the special situation of family caregivers.
Objectives and Methodology: A randomized
controlled trial (N = 229) was conducted to compare the
treatment group CBT intervention, treated control group
(relaxation techniques) and untreated control group.
Outcome measures were physical complaints, depressive
symptoms, caregivers’ subjective distress and quality
of life. All measures were administered before treatment
(pre), after treatment (post), six months, and one year after
treatment (follow-up).
Results: Caregivers in the CBT intervention group show
positive long-term effects on health outcomes such as
significant increases in quality of life and reduction in
body complaints. Taking participants’ evaluation of the
intervention into account, CBT shows a higher effect
concerning overall satisfaction with the treatment, pointing
to intervention specific effects compared to the general
effects of an intervention, which have been controlled by
the introduction of an active control group (PMR).
Discussion and Conclusion: Discussion focuses on
limitations and challenges of the investigation of longterm-effects in this population, because of the high
134
mortality rate of persons with dementia. Considerations
will be undertaken regarding the evaluation of specific
intervention modules and the implementation of this
specific psychotherapy for caregivers into the health
system.
S56-05
Grief in Dementia Caregivers German Validation
of the Marwit Meuser Grief Inventory. Benefits
for research and practice
Denise Schinköthe1; Marie-Ann Sengewald1; Franziska
Meichsner1; Gabriele Wilz1
1
University of Jena, Germany
Background: Dementia caregivers are at an increased
risk of mental and physical problems as a result of the
strain that accompanies this role. Although research
has focused on the sense of burden and depression that
caregivers experience, little reference has been made to the
feelings of grief and loss reported by caregivers. Due to the
multidimensionality of grief, with its physical, emotional,
and psychological expression, clinical symptoms of grief
are often misinterpreted as symptoms of depression. With
the development of a grief scale, specifically designed
for caregivers of individuals with Dementia (Marwit &
Meuser, 2002), clinical professionals are better able to
identify feelings of grief and loss and subsequently provide
appropriate treatment.
Aim: German Validation and first Confirmatory Factor
Analysis of the Marwit Meuser Caregiver Grief Inventory
(MM-CGI).
Method: A total of 142 caregivers of a patient with
dementia were interviewed with the translated 50-item
MM-CGI. Also administered were the CES-D, the Geriatric
Depression Scale, the Berlin Inventory of Caregivers
Burden (BIZA-D), as well as quality of life questionnaire
(WHOQoL-Bref).
Results: Confirmatory Factor Analysis resulted in a
reduced 24 item scale containing three factors: (1)
Personal Sacrifice, (2) Heartfelt Sadness and Longing and
(3) Worry and Burden. Cronbachs alpha scores indicating
high internal consistency reliability for each factor, as well
as for their combined total. Convergent and divergent
validity coefficients were appropriate. The results become
understandable in light of the literature, which differentiates
grief from depression and burden.
Discussion: Results suggest that usefulness of the
instrument not only as a research instrument but as a
clinical diagnostic tool for identifying areas amenable to
constructive intervention
EABCT 2012
Motivorientierte Therapiebeziehungen:
Voraussetzungen und ZusammenhSang mit
Therapieerfolg
Isabelle Schmutz Held1; Franz Caspar1; Thomas Berger1
1
University of Bern, Switzerland
Eines der konstantesten Ergebnisse der Therapieforschung
ist der Zusammenhang zwischen Variablen der
therapeutischen Beziehung und Outcome. Dieser
Zusammenhang ist allerdings nur mittelgross. Gründe dafür
könnten zum einen fehlende therapieschulunabhängige
präskriptive Konzepte und zum anderen ein Artefakt der
Methodik sein: es ist nicht plausibel, dass einzelne, direkt
quantitativ gemessene Beziehungsvariablen über ein
grösseres Kollektiv von PatientInnen hinweg in gleicher
Weise mit Outcome-Merkmalen zusammenhängen.
Plausibler ist, dass die Passung (Responsiveness) von
TherapeutInnen und PatientInnen im Sinne eines adaptiven
Beziehungsangebots mit dem Outcome positiv korreliert.
Das Modell der “motivorientierten Beziehungsgestaltung”
(früher „komplementäre Beziehungsgestaltung“ genannt)
nach Grawe und Caspar schliesst diesen Begriff der
Passung ein und stellt einen präskriptiven Ansatz dar.
Nach diesem Modell sollte das Beziehungsverhalten der
TherapeutInnen den wichtigsten individuellen Bedürfnissen
und Zielen der PatientInnen angepasst werden. Die
individuellen Bedürfnisse und Ziele der PatientInnen
werden mit Hilfe der Plananalyse (Caspar, 1995)
erschlossen. Motivorientiertes Verhalten heisst, sich als
TherapeutIn im Sinne einer Verwirklichung der akzeptablen
Ziele bzw. Pläne der PatientInnen zu verhalten. Die
Beurteilung des realisierten Ausmasses an motivorientierter
Beziehungsgestaltung kann auf der Basis einer genauen
Analyse der Beziehungssituation vorgenommen werden.
Die vorliegende Studie versteht sich als Weiterführung
der Studie von Caspar, Grossmann, Unmüssig und
Schramm (2005) zum Komplementaritätskonzept, die
deutliche Zusammenhänge zwischen Ausmass der
motivorientierten Beziehungsgestaltung und Outcome
gefunden haben. Der Zusammenhang zwischen
motivorientierter Beziehungsgestaltung und Outcome,
zwischen interpersonellen Merkmalen der PatientInnen und
motivorientierter Beziehungsgestaltung sowie der mögliche
Einfluss anderer Faktoren (z.B. Diagnosen der PatientInnen
oder Geschlechterkombination zwischen TherapeutIn und
PatientIn) werden anhand einer grösseren Stichprobe
untersucht.
EABCT 2012
Wie können kognitiv-psychologische Grundlagen
zum Verständnis korrektiver Erfahrungen
beitragen?
Nicola Ferrari1; Franz Caspar1
1
University of Bern, Switzerland
Einführung: Korrektive Erfahrungen besitzen per
definitionem das Potential, Individuen in eine adaptive
Richtung zu verändern. Obwohl einige Therapeuten
ihre Patienten wie Baukästen anschauen, in denen ein
Block durch einen anderen ausgetauscht, oder wie
Computerprogramme, bei denen ein Algorithmus durch
einen anderen ersetzt werden kann, überzeugen solche
Sichtweisen nicht. Es ist plausibler anzunehmen, dass
Patienten wie dynamische Systeme funktionieren, welche
von Therapeuten nur mitbeeinflusst, aber nicht direkt
verändert werden können.
Ziele: Neuronale Netzwerkmodelle (konnektionistische
Modelle) aus der allgemeinen kognitionswissenschaftlichen
Forschung werden auf korrektive Erfahrungen angewandt.
Damit werden deren grundlegenden Erscheinungsformen
und Entwicklungsmuster definiert. Die Angemessenheit
der Modelle wird anhand von Patientenberichten über
korrektive Erfahrungen geprüft.
Methoden: Die Stichprobe umfasst 50 Patienten mit
einer laufenden oder abgeschlossenen integrativen
Verhaltenstherapie. Patientenberichte werden zu je einer
Therapiesitzung pro Patient mit dem „Brief Structured Recall“
und am Therapieende mit einem halbstandardisierten
Interview erhoben. Die Datenauswertung ist hauptsächlich
qualitativ und basiert auf dem State of Mind-Konzept nach
Horowitz sowie auf Prinzipien des „Consensual Qualitative
Researchs“.
Ergebnisse: Erste Ergebnisse zeigen, dass die postulierten
Muster zu den Patientenbeschreibungen von korrektiven
Erfahrungen zu passen scheinen. Am Kongress werden
Ergebnisse aus einer grösseren Stichprobe berichtet.
Diskussion: Die praktische Relevanz der häufigsten
Muster korrektiver Erfahrungen bildet den Kern der
Diskussion. Besonderheiten der Stichprobe und der
angewendeten Therapieform, welche die Ergebnisse
beeinflussen können, sowie Einschränkungen des
Forschungsansatzes werden ebenfalls berücksichtigt.
Schlussfolgerungen: Es darf angenommen werden,
dass die Grundaspekte konnektionistischer Modelle auf
einfache Weise verstanden werden können. Damit lassen
sich Beschreibungen therapeutischer Prozesse ableiten,
die für Therapeuten und Patienten praktisch relevant sein
können.
135
57
S57-01
S57-02
Symposium
Symposium 57 - Aspekte der
therapeutischen Beziehungsgestaltung
und Beschreibung klinischer Prozesse
Symposium
57
S57-03
S57-04
Selbstregulierte und eigendynamische Prozesse
suizidalen Verhaltens
Juliane Brüdern1; Thomas Berger1; Konrad Michel2; Anja
Maillart2; Franz Caspar1
1
University of Bern, Switzerland; 2University Hosiptal of
Psychiatry, Bern, Switzerland
Motivorientierte Beziehungsgestaltung vs.
Konfrontation: Wie viel ist jeweils nötig?
Patrick Figlioli1; Franz Caspar1; Isabelle Schmutz1
1
University of Bern, Switzerland
Einleitung: Die Motivorientierte Beziehungsgestaltung
(MOTHER) ist ein präskriptiver Ansatz, um eine solide
Basis für jegliche therapeutische Arbeit herzustellen. Die
Interventionen des Therapeuten sind auf die Bedürfnisse
und Ziele des Patienten zugeschnitten, die gezielt
befriedigt werden. Diese Bedürfnisse können mit Hilfe
der Plananalyse von Caspar (1995) erschlossen werden.
Je nach Ausmass der Komplementarität des Therapeuten
(Befriedigung der Patientenbedürfnisse) wird eine
gute Therapiebeziehung hergestellt, was ein positives
Therapieergebnis begünstigt.
Ziele: Der Zusammenhang zwischen MOTHER und dem
Therapieergebnis wurde schon mehrfach belegt (Grawe,
1990, Caspar, 2005). Jedoch blieb die Frage, welchen
Einfluss Konfrontation (intuitiv als antikomplementär zu
beurteilen) auf die Therapiebeziehung, sowie den Outcome
hat. Schliesslich war die Beurteilung der Konfrontation
durch den Patienten auch von Interesse.
Methodik: 30 Fälle aus einem Pool von 160 Therapien
wurden ausgewählt, die entweder eine gute oder schlechte
Therapiebeziehung im Sinne von MOTHER repräsentierten.
Zwei Anfangssitzungen, je eine von der Mitte und dem
Ende der Therapie wurden auf das komplementäre bzw.
antikomplementäre Therapeutenverhalten bewertet.
Die Bewertung der Konfrontation wurde mit dem
Patientenstundenbogen von Regli (2000) erhoben.
Ergebnisse: Ein gutes Therapieergebnis korrelierte
signifikant mit einem hohen Ausmass von
Komplementarität, wenn ebenfalls wenige konfrontative
Sequenzen in der gleichen Sitzung vorkamen.
Das gleichzeitige Auftreten von konfrontativem
und komplementärem Therapeutenverhalten hatte
ebenfalls einen signifikanten Zusammenhang mit der
Patienteneinschätzung des Therapiefortschritts und der
Therapiebeziehung.
Diskussion: Die Ergebnisse zeigen, dass es einerseits
gut ist, eine solide Therapiebeziehung herzustellen, man
sich aber andererseits nicht fürchten soll, bei Bedarf
heisse Eisen in der Therapie anzufassen. Die Erkenntnisse
sind in Einklang mit Sachses Metapher, die besagt,
Beziehungskredite zu sammeln, diese aber auch wieder
aufzubrauchen.
Hintergrund: In den letzten zehn Jahren wurde eine
Vielzahl von Suizidtheorien entwickelt. Suizidversuche
sind dennoch sehr schwer vorhersagbar. Teilweise können
Betroffene nach einem Suizidversuch rational nicht mehr
nachvollziehen, wie sie diese Handlung ausführen konnten.
In dieser qualitativen Studie wird untersucht, ob sich
Teilaspekte der suizidalen Handlung als eigendynamische
Prozesse anhand von konnektionistischen Modellen
einordnen lassen.
Methode: Die Stichprobe besteht aus 15 Personen,
die nach einem Suizidversuch hospitalisiert wurden.
Für die qualitative Einzelfallanalyse wurden narrative
Interviews untersucht, in denen die Personen die suizidale
Handlung nochmals rekonstruierten. Die Interviews
wurden im Rahmen der Assip-Studie von Prof. Michel
durchgeführt. Es wurden Kriterien festgelegt, anhand
derer sich eigendynamische Prozesse definieren lassen.
Die Aussagen der Patienten wurden hinsichtlich dieser
Kriterien überprüft.
Ergebnisse: Es gibt erste Hinweise darauf, dass während
der suizidalen Handlung eigendynamische Prozesse
ablaufen. Zudem zeigte sich, dass eigendynamische
Prozesse auch ausserhalb des suizidalen Verhaltens
auftraten und diese als bedrohlich wahrgenommen
wurden. In diesem Fall wurden Suizidgedanken und der
Suizidversuch als Copingstrategie verwendet, um subjektiv
wahrgenommene Handlungskontrolle zurückzuerlangen.
Diskussion: Konnektionistische Modelle werden
hinsichtlich ihres theoretischen und klinischen Nutzens für
das Verständnis suizidaler Handlungsabläufe diskutiert.
136
EABCT 2012
Application d’une stratégie thérapeutique TCC
chez un jeune enfant anxieux
Pierina Rogg Bazzano1
1
Private Practice, Lausanne, Switzerland
Description clinique: Je vais parler d’un jeune garçon
de 10 ans qui souffre d’un trouble anxieux. Au cours d’un
traitement logopédique pour un retard de langage et un
bégaiement, il consulte pour la première fois pour des
peurs à l’intérieur de la maison. Il a peur du noir, de la
mort. Il sera discuté du diagnostic différentiel d’un trouble
anxieux chez l’enfant et de l’application d’une stratégie
thérapeutique TCC.
Objectif thérapeutique: Les parents sont inquiets par
rapport à la persistance chez leur fils d’une peur invalidante
du noir, d’une peur d’aller seul à la cave et d’une incapacité
à dormir dans sa chambre.
Le traitement consiste en une exposition progressive aux
situations phobogènes.
Résultats: La peur de la cave a diminuée après quelques
séances. Grâce à des expositions brèves et régulières, cet
enfant va à la cave seul. Le comportement d’évitement a
baissé. Celui de rester dans sa chambre pour dormir a été
amélioré grâce à une exposition accompagnée d’une auto
observation du garçon et d’une évaluation écrite consignée
du niveau de son angoisse. Il dort dans son lit toute la nuit.
Il a moins peur du noir.
Discussion et conclusion: Il paraît important
d’investiguer l’aspect différentiel du trouble anxieux
chez l’enfant. La dépression et le TOC sont à prendre en
considération. Si on n’est pas sûr d’un résultat, un test
thérapeutique peut être décisif. Ce dernier peut apporter
des arguments en faveur d’un trouble anxieux ou d’un
trouble compulsif. Il permet aussi de tester l’accessibilité
du patient au traitement.
EABCT 2012
Entraînement à l’ouverture émotionnelle avec
des groupes d’enfants
Fabrice Brodard1
1
University of Lausanne, Switzerland
Les premières années de vie de l’être humain sont
marquées par un développement important des capacités
de régulation émotionnelle (Brodard, Quartier & Favez,
2011). Ces capacités sont notamment associées au
développement des compétences sociales de l’enfant, qui
permettent par exemple de créer et maintenir des relations
harmonieuses avec les pairs. Toutefois, lorsqu’elles
sont déficitaires, elles sont également assciées au
développement et au maintien de troubles psychiques
au cours de l’enfance. Différents types de déficits de la
régulation émotionnelle caractérisent les enfants ayant
des problèmes internalisés ou externalisés. Dans cette
présentation, nous aborderons un exemple d’intervention
avec des groupes d’enfants présentant des problèmes
émotionnels et/ou comportementaux, en nous basant
sur le modèle de l’Ouverture émotionnelle (OE) proposé
par Reicherts, Genoud et Zimmermann (2011). Nous
présenterons entre autres de nouveaux instruments
permettant d’évaluer les caractéristiques de la régulation
des émotions et de l’Ouverture émotionnelle dans la
famille. Ces mesures permettent de conceptualiser des
interventions spécifiques visant à développer chez les
enfants certains aspects de l’ouverture aux émotions,
en fonction des ressources et déficits de l’enfant (p.ex.
Perception des indicateurs internes des émotions,
Perception des indicateurs externes, Communication des
émotions, etc.). Les différents modules d’intervention sont
basés sur des techniques issues des thérapies cognitives
et comportementales, proposant divers exercices,
démonstrations et jeux de rôle. Les premiers résultats
d’une étude pilote montrent des progrès cliniquement
significatifs des enfants sur différents indicateurs
(évaluation des parents et auto-évaluation de l’enfant). Ils
sont encourageants pour poursuivre le développement de
ces interventions en groupe, qui peuvent être complétées
par des interventions avec les parents et/ou les enseignantes de ces enfants.
137
58
S58-01
S58-02
Symposium
Symposium 58 - TCC chez l’enfant: les
interventions ciblées
S58-03
S58-04
TCC et deuil chez l’enfant entre 8 et 11 ans
Alexandra Lebrun1
1
Fondation As’trame & Private Practice, Switzerland
Une nouvelle approche de l’intervention précoce
en autisme
Bernadette Rogé1
1
Université de Toulouse le Mirail, & CERESA (Centre
d’Education et de Services pour l’Autisme), France
Symposium
58
La mort d’une personne proche (mère, père, frère, sœur)
pour l’enfant représente selon Bowlby un « traumatisme
de perte ». Pour l’enfant le deuil et le traumatisme sont
deux concepts inextricables. Le parent, le frère, la sœur ne
meurent pas de vieillesse mais d’un accident, d’un acte de
violence, d’un suicide ou suite à une maladie.
La prise en charge des enfants endeuillés doit prendre en
compte les circonstances du deuil, le fait que l’enfant soit
présent ou non sur le lieu de l’accident, s’il a vu ou non le
corps accidenté ou inanimé, l’arrivée de la police, l’équipe
médicale, les soins d’assistance au blessé, les réactions
de deuil des autres personnes témoins et comment s’est
déroulé la séparation de l’enfant avec le corps de la
personne endeuillée.
L’enfant est gêné par des « images parasites », il associe
la personne décédée aux images traumatisantes. Le deuil
chez l’enfant est associé à l’anxiété.
Le soutien psychothérapeutique en thérapie cognitivocomportementale d’un enfant entre 8 et 11 ans se centre
sur différents niveaux :
• l’évaluation de l’enfant, quelles sont les réactions
normales qui appartiennent au deuil,
• diagnostiquer s’il y a ou non présence d’un syndrome de
stress post-traumatique et le traiter,
• permettre à l’enfant d’accepter ses émotions, les
normaliser et connaître leurs fonctions,
• travailler les croyances en lien avec le deuil,
• avec les parents renforcer les compétences parentales,
les accompagner dans le soutien qu’ils peuvent apporter
à l’enfant, comment le rassurer, le valider dans son vécu
émotionnel et l’accompagner dans l’irréversibilité de la
mort et non esquiver le sujet.
138
Le diagnostic d’autisme est actuellement plus précoce.
L’intérêt de l’identification des troubles au plus jeune
âge est de permettre la mise en œuvre d’une intervention
susceptible de soutenir le développement de l’enfant et
d’aider la famille à faire face à la situation.
Objectifs: L’objectif de cette présentation est de montrer
l’évolution des pratiques d’intervention auprès des enfants
atteints d’autisme et d’illustrer la mise en œuvre du Early
Start Denver Model (ESDM), spécifiquement construit
pour l’intervention auprès de très jeunes enfants. Les
principes de base de l’ESDM), seront présentés ainsi que
la méthodologie d’évaluation, d’élaboration des objectifs
et de recueil des données au cours de l’évolution. Des
résultats préliminaires seront présentés.
Methodologie: 18 enfants atteints d’autisme, âgés
de 24 à 48 mois ont bénéficié de cette intervention.
La méthode des protocoles à cas unique est utilisée
pour suivre la progression des enfants. La checklist de
l’ESDM a été utilisée pour établir la ligne de base pour
des comportements-cible tels que l’attention conjointe,
l’imitation, la communication. Les comportements ont
ensuite été enregistrés chaque semaine.
Resultats: Une amélioration significative des
comportements travaillés est enregistrée. Les résultats
sont dans l’ensemble excellents, cependant l’évolution est
inégale d’un enfant à l’autre. Quelques profils d’évolution
seront présentés.
Discussion: Les variations d’évolution peuvent être
reliées à certains facteurs comme le degré d’autisme, le
potentiel de départ et l’implication de tous les partenaires.
Conclusion: Le style d’interaction proposé dans
l’ESDM et la méthodologie utilisée pour promouvoir le
développement sont propices à l’apprentissage chez de
très jeunes enfants atteints d’autisme mais le degré de
progression varie en fonction de facteurs propres à l’enfant
et à son environnement.
EABCT 2012
Tailored vs. Standardized Internet-Based
Cognitive Behavior Therapy for Depression and
Comorbid Symptoms: A Randomized Controlled
Trial
Gerhard Andersson1
1
Linköping University, Sweden
Background: Major depression can be treated by means
of cognitive behavior therapy, delivered via the Internet as
guided self-help. Individually tailored guided self-help
treatments have shown promising results in the treatment
of anxiety disorders. This randomized controlled trial
tested the efficacy of an Internet-based individually tailored
guided self-help treatment which specifically targeted
depression with comorbid symptoms. The treatment was
compared both to standardized (non-tailored) Internetbased treatment and to an active control group in the form
of a monitored online discussion group. Both guided selfhelp treatments were based on cognitive behavior therapy
and lasted for 10 weeks. The discussion group consisted
of weekly discussion themes related to depression and the
treatment of depression.
Method: 121 participants with diagnosed major
depressive disorder and with a range of comorbid
symptoms were randomized to three groups. The tailored
treatment consisted of a prescribed set of modules
targeting depression as well as comorbid problems. The
standardized treatment was a previously tested guided
self-help program for depression.
Results: From pre- to post-treatment, both treatment
groups improved on measures of depression, anxiety
and quality of life. The results were maintained at a
6-month follow-up. Subgroup analyses showed that
the tailored treatment was more effective than the
standardized treatment among participants with higher
levels of depression at baseline and more comorbidity,
both in terms of reduction of depressive symptoms and
on recovery rates. In the subgroup with lower baseline
scores of depression, few differences were seen between
treatments and the discussion group.
Conclusions: This study shows that tailored Internetbased treatment for depression is effective and that
addressing comorbidity by tailoring may make guided
self-help treatments more effective than standardized
approaches in the treatment of more severe depression.
EABCT 2012
Individually-tailored, Internet-based treatment
for anxiety disorders in primary care: A
randomized controlled trial
Lise Bergman Nordgren1
1
Linköping University, Sweden
Introduction: Internet-administered cognitive behavioural
therapy (iCBT) with minimal to moderate therapist guidance
has been found to be effective for a range of anxiety
disorders. However, most studies have focused on one
specific primary diagnosis and co-morbidity has not been
considered. A new approach to Internet-based treatment
involves tailoring the treatment according to the patient’s
unique characteristics and comorbidities. A recent study
on a heterogeneous sample showed significant results
both immediately following treatment and at 1 and 2 year
intervals. However, it was a self-recruited sample.
Objectives: The aim were to investigate if iCBT, tailored
according to symptom profile and patient characteristics,
can be a feasible treatment for primary care patients
with anxiety disorders, and to study if treatment effects
sustained at 1 year follow-up.
Method: Participants with anxiety disorders were
recruited from a primary care population by their mental
health professional. Participants then applied via the study
web-site by filling out standardized self-report measures
and 10 additional questions regarding history of treatment
and demographics. These measurements served as pretreatment assessment. A total of 102 participants were
included after an in-person, semi-structured diagnostic
interview and randomized to either treatment or active
control. Measure points were baseline, post treatment
and 12 months follow-up. Treatment consisted of 6-10
individually-prescribed modules in conjunction with
scheduled online therapist guidance.
Results: Analysis revealed superiority of the treatment over
the control condition at post treatment, and preliminary
data indicates sustained effects at 1 year follow-up. By the
time of the conference all data will have been collected and
processed.
Conclusion: Tailored internet-based therapy may be
a feasible approach in the treatment of anxiety in a
heterogeneous primary-care population.
139
59
S59-01
S59-02
Symposium
Symposium 59 - Managing comorbidity
during internet treatment using
tailored and transdiagnostic treatment
approaches
S59-03
S59-04
Transdiagnostic internet-delivered cognitive
behaviour therapy: Treating internalising
disorders with a generic treatment protocol
Nick Titov1
1
Macquarie University, Sydney, Australia
Do we need a therapist? Examining the relative
benefits of coach-guided and self-guided
transdiagnostic internet-delivered cognitive
behaviour therapy for internalising disorders:
Results from two RCTs
Blake Dear1
1
Macquarie University, Sydney, Australia
Symposium
59
Objectives: Approximately 50% of patients with an
anxiety disorder meet diagnostic criteria for another anxiety
disorder or major depressive disorder. These disorders are
characterised by similar symptoms and respond to similar
treatments. Transdiagnostic treatments which target
symptoms common to depression and anxiety disorders,
may be an effective strategy for treating more than one
disorder using the same treatment protocol.
Method: This talk will present the results of three
randomised controlled trials (N=294) that explored the
efficacy of transdiagnostic internet-delivered cognitive
behavioural treatment (iCBT) protocols targeting
symptoms of major depressive disorder, generalised
anxiety disorder, social phobia, and panic disorder with/
without agoraphobia. All designs compared guided iCBT
vs. waitlist control, with participants receiving access to
online lessons, and weekly support from a therapist or
guide.
Results: Severity of symptoms, as measured by diagnostic
interview and symptom measures, significantly reduced
following transdiagnostic iCBT in all studies, with results
sustained at 3-month follow-up. Importantly, severity
of symptoms of co-morbid symptoms also reduced.
Less than 90 minutes of clinician time was required per
participant across each treatment protocol, indicating
the cost effectiveness of the treatments. Importantly,
participants reported a high level of satisfaction with the
intervention.
Conclusions: Outstanding questions remain about the
relative benefits of disorder-specific vs. transdiagnostic
treatments, and the optimum models of service
provision. Moreover, larger samples are required to test
relative benefits across target disorders. However, these
studies provide encouraging evidence for the efficacy
of transdiagnostic iCBT and contribute to an emerging
evidence base indicating this approach has considerable
potential in improving access to effective treatment for the
internalising disorders.
140
Objectives : Epidemiological surveys indicate the
numbers who require mental health services far exceeds
the number of available health professionals. Providing
self-guided or coach-guided (non-clinician) administered
interventions may be a suitable first low-intensity step in a
stepped-care treatment model.
Method: This talk describes two randomised controlled
trials (RCT) exploring methods of administering
transdiagnostic Internet-delivered cognitive behavioural
therapy (iCBT) protocols. The first RCT (N=131) examined
the relative benefits of clinician-assisted (CLA) vs. coachassisted (CA) treatment vs. waitlist control (Control) iCBT.
Individuals met DSM-IV criteria for a principal diagnosis
of GAD, social phobia or panic disorder with or without
agoraphobia. Treatment consisted of an 8 lesson /10
week iCBT program with weekly contact from a clinician
or coach. The second RCT (N=250) examined the relative
benefits of automatic email reminders (Reminders) vs.
none (No Reminders) vs. Waitlist Control during a 5
lesson/8 week self-guided transdiagnostic iCBT course.
Individuals met clinical cut-offs on self-report measures
of anxiety and depression.
Results: In the first RCT, the CA condition resulted in
similar improvements to the CLA condition at posttreatment and follow-up, while both treatment conditions
were superior to Controls. Analyses using the pooled
outcomes for the treatment groups (CLA+CA) revealed
significant reductions on disorder-specific outcomes for
each of the three target diagnoses, and large effect sizes.
Results from the second RCT indicated that the Reminders
group obtained superior outcomes at post-treatment, while
the No Reminders group obtained superior outcomes to
the Control group. Data from the 3-month follow-up will
be reported.
Conclusions: Coach and self-guided transdiagnostic
iCBT interventions may be efficacious models for
increasing access to treatment.
EABCT 2012
Background: Previous studies on Internet-based
treatment with minimal therapist guidance have shown
promising results for a number of specific diagnoses.
Objective: Our aim is to investigate the effects of a tailored
therapist guided internet-based treatment for different age
groups with anxiety symptoms. In our first trial our aim
was to examine if two age groups (18-30 years and 31-45
years) would respond differently to the treatment. Three
other trials are in progress to examine if teenagers, young
adults and older adults respond equally to treatment.
Method: In the first trial, 149 participants were recruited
from an online list of individuals having expressed an
interest in internet treatment. Screening consisted of
online questionnaires followed by a telephone interview.
A total of 57 participants were included after a semistructured diagnostic interview and randomized to an 8
week treatment program (N=29) or to a control condition
(N=28). Treatment consisted of individually prescribed
cognitive behaviour therapy text modules in conjunction
with online therapist guidance. The control group
consisted of a waitlist who later received treatment. The
second and third trial are pilot studies is clinical settings
where we aim to include 30 participants in each. The forth
trial with older adults is a randomized controlled trial.
Results: All dependent measures improved significantly
immediately following treatment and at the 12-month
follow-up in the first trial. The between-group effect size
on the primary outcome measure, the Panic Disorder
Severity Scale, was d = 1.41 (95% confidence interval
0.81–1.95) at posttreatment. The within-group effect size
from pretreatment to 12-month follow-up was d = 1.66
(95% confidence interval 1.14–2.35). Age group had no
effect, suggesting that age did not influence the outcome.
Conclusions: Tailoring the internet-based treatment
can be a feasible approach in the treatment of anxiety
symptoms and comorbid depressive symptoms. Younger
adults benefit as much as adults over 30 years up to 45
years.
EABCT 2012
S60-01
Effectiveness of integration of CBT and
medication in bipolar disorder
Cristina Terribili1
1
Gruppo Accademia di Ricerca e Formazione
Clinicopedagogica e Psicosociale, Rome, Italy
Background: Scientific literature agreeably recognizes
that combining medication and psychotherapy may help
prevent relapse in bipolar disease but is uncertain about
which psychotherapy can really help patients.
Method: Two patients with Bipolar 2 disorder, with long
histories on medication and psychotherapy treatments
(psychoanalysis, 3 times a week for 5 years, and Jungian
therapy 1 time a week for 2 years), were treated using CBT
strategies.
Results: In the past, the patients had been hospitalized
during the relapses because they were unable to prevent
or cope during critical phases of the illness. During CB
Therapy, patients were able to monitor mood, seek advice
from psychiatrist to adjust medial therapy and face the
symptoms without recourse to psychiatric hospitalization.
Conclusion: It’s agreed that bipolar disorder is a lifelong
and recurrent illness, and patients need long-term
treatment to maintain control of bipolar symptoms. CBT
empowers and enables the patients to face the disease and
prevent relapse through benefits in self-esteem, improving
overall functioning, and achieving a better quality of life.
141
60
Does age make a difference?
Kristin Silfvernagel1, Per Carlbring2; Gerhard Andersson1,3
1
Linköping University, Sweden; 2Umeå University,
Sweden; 3Karolinska Institutet, Stockholm, Sweden
Symposium 60 - Cognitive therapy for
challenging disorders
Symposium
S59-05
S60-02
S60-04
CBT treatment of Bipolar patients: Wellness
planning during euthymia
Kim Coon1
1
University of Oklahoma, USA
Cognitive behavioural factors in obsessive
compulsive disorder: New research findings
Hakan Turkcapar1; Yasir Safak1, Turkan Dogan1, Emrah
Karadere1
1
Diskapi YB Research and Training Hospital, Ankara, Turkey
Symposium
60
An important skill set for CBT is the ability to assist patients
developing strategies to maintain treatment gains, prevent
relapse, and plan for wellness. For patients with bipolar
disorder, these are exceptionally important tasks because
of the range of symptoms, mood states, and behaviors to
be addressed.
For example, there is a need for preparing a balance
between pleasurable activities and interactions during
depressive episodes as well as developing a plan for
reducing pleasure seeking and risky behaviors during
manic and hypomanic episodes. This presentation will
review strategies to alert patients for signs of relapse, to
promote continued implementation of CBT techniques that
enhance mood stability and to add behaviors that promote
wellness
S60-03
CBT with psychotic adults in an urban health care
setting: Preliminary results of an effectiveness
trial
Mark Reinecke1
1
Northwestern University, Chicago, USA
142
Although cognitive behavioral therapies are very effective
in the treatment of obsessive compulsive disorder, some
patients do not benefit neither cognitive behavioral
therapies nor drug therapies. Most of the cognitive theories
about obsessive compulsive disorder view dysfunctional
appraisals as the key cognitive process hat leads to
problematic frequent obsessions. In this regard over
estimation of threat, inflated responsibility, intolerance to
uncertainty, thought action fusion were seen as important
cognitive factors in OCD. Behaviorally, avoidance and
neutralization are the main maintenance factors in OCD.
Cognitive behavioral interventions developed to change
these processes.
To examine and refine these processes we conducted a
series of studies with obsessive compulsive patients in our
outpatient unit. In our first trial 80 patients were evaluated in
order to examine their symptomatology, appraisals, degree
of their beliefs, avoidance and neutralizations. They were
assessed with YBOCS, Padua and Maudsley inventories, a
questionnaire which is developed in our center. In a second
study we recruited 45 patients into 14 weeks cognitive
behavioral group therapy. In this study to assess patients
obsessive compulsive symptomatolgoy we used YBOCS,
Padua and Maudsley inventories, White Bear test, Inferential
Confusion Test, Though-Action Fusion questionnaire.
Cognitive behavioral therapy protocol in sequence, consists
of psycho-education, motivational component, cognitive
interventions, and lastly behavioral interventions namely
exposure response preventions. As a control treatment we
also conducted support therapy group with OCD patients;
in these support group therapy setting, patients also took
psychoeducation about OCD. We compare these two groups
in terms of their improvement; also in the therapy group we
followed their progress and the relation of the progress with
the interventions that made. According to primary results
patients were responded to CBGT very well and CBGT
groups significantly better than the control group according
YBOCS end score. Although psycho-education help to
some extent, radical improvement in patients were seen after
cognitive intervention and with the behavioral interventions
further improvement were seen. Interestingly in responded
patients, YBOCS, White Bear, Inferential Confusion scores
dropped at the end of the treatment but their TAF scored
did not changed significantly. Now all patients groups in
the follow up period. We are also planning to measure their
scores in next 2 year period.
EABCT 2012
Interpretation Bias in Children with Generalized
Anxiety Disorder
Mike Rink1; Anke Klein1; Rian Bakens1; Rianne van
Niekerk1; Eni S Becker1
1
Radboud University Nijmegen, The Netherlands
Introduction: Previous research has shown that
anxious children show cognitive biases which favor the
processing of threat-related stimuli. One of these biases is
interpretation bias: Ambiguous stimuli are interpreted as
threatening, even though neutral or positive interpretations
would be possible. This way, the world is seen as more
dangerous than it really is, maintaining anxiety. An open
question regarding this interpretation bias is its specificity,
particularly in Generalized Anxiety Disorder (GAD): Would
children with symptoms of GAD show an interpretation
bias only for materials related to their main worries and
fears, or also for other negative materials?
Objectives and Methodology: In order to minimize
demand effects, this study using an Auditory Interpretation
Task (AIT) to examine interpretation bias and its contentspecificity in children with symptoms of GAD. In this AIT,
two words that differ by only one phoneme are «blended»
and presented auditorily. In this case, perceivers hear one
or the other word, usually without realizing that another
interpretation would be possible. Here, one word always
had a neutral valence, and the other word was positive,
related to GAD, related to spider fear, or related to general
fear. In total, 223 children performed a multiple-choice
version of this AIT, and 226 children performed an openended version.
Results: As expected, a specific interpretation bias was
found: Children with symptoms of GAD showed more
negative interpretations of ambiguous GAD-related word
blends than non-fearful children, but not of other blends.
This result was found with the multiple-choice version
of the AIT; the open-ended version did not yield any
differences.
Discussion and Conclusion: The findings support the
idea that fearful children display cognitive biases that are
specific for fear-relevant stimuli.
EABCT 2012
Don’t Panic: Interpretation Bias is Predictive for
Incidence of Panic Disorder
Eni Becker1; Marcella L. Woud1; Xiao Chi Zhang2; Jürgen
Margraf2
1
Radboud University Nijmegen, The Netherlands; 2Ruhr
Universität Bochum, Germany
Introduction: Cognitive models of panic disorder
postulate that misinterpretations of ambiguous, threatening
material is an important, maintaining factor of the disorder.
However, demonstrations of whether such a bias precedes,
and thus is predictive for developing a panic disorder, are
missing.
Objectives and Methodology: The present study used
Data from an epidemiologic study (i.e., the Dresden
Prediction Study) in which a community sample of young
German women was tested at two time points allowing to
study biased interpretation as a risk factor. At time point
one, participants were required to fill in an interpretation
questionnaire including two types of ambiguous scenarios:
panic-related and general threat-related.
Results: Analyses revealed that exhibiting a panicrelated interpretation bias was predictive for developing
a panic disorder at time point two. But, an interpretation
bias towards ambiguous, general threat-related scenarios
also significantly increased the risk for the incidence of a
panic disorder. Albeit, the panic-related interpretation bias
was a stronger predictor. Different pattern emerged for the
prediction of remission.
Discussion and Conclusion: Interestingly the specific as
well as the more general threat bias predicted later onset of
panic disorder, probably showing a generalization of threat
triggers. This is the first study to show the relationship
between interpretation bias an later onset of panic disorder,
and therefore adds to our current understanding of the role
of interpretation biases in panic disorder.
143
61
S61-01
S61-02
Symposium
Symposium 61 - Assessment and
Modification of Biased Cognitive
Processes across Emotional Disorders:
A Matter of Interpretation
Symposium
61
S61-03
S61-04
Does training positive interpretation and imagery
reduce symptoms of depression? A first test of a
novel intervention versus a control condition
Simon Blackwell1; Tamara J. Lang1; Catherine J. Harmer1;
Phil Davison2; Emily A. Holmes1
1
University of Oxford, United Kingdom, 2Oxfordshire
Mental health Care NHS Trust, United Kingdom
Introduction: Depression is characterized by a tendency
to interpret information in a negative way -a negative
interpretation bias – and a deficit in generating positive
imagery of the future. A computerized “Cognitive Bias
Modification” procedure designed to train positive
interpretation and imagery may therefore have potential
as an innovative treatment for depression. An initial study
(Blackwell & Holmes, 2010) provided preliminary evidence
for the efficacy of such a CBM paradigm in depression, but
was limited by the lack of a control condition.
Objectives and Methodology: This study aimed to
investigate the potential clinical use of CBM targeting
imagery and interpretation, by comparing the impact of
repeated sessions of a ‘multi-component’ CBM to a control
condition. The CBM incorporated three complementary
paradigms: auditory presentation of training scenarios,
a ‘picture-word’ CBM, and a CBM targeting appraisals
of intrusive memories. Twenty-six currently depressed
individuals were randomly allocated to complete either
positive imagery CBM or a control condition daily at home
over one week. Outcome measures were collected pre and
post-treatment, and at a two-week follow-up.
Results: Individuals in the positive condition demonstrated
significant improvements from pre-treatment to posttreatment in depressive symptoms, cognitive bias and
intrusive symptoms compared to those in the control
condition. Improvements in depressive symptoms at twoweek follow-up were at trend level compared to the control
condition.
Discussion and Conclusion: The results of this
first controlled comparison of positive imagery and
interpretation CBM for depression provide evidence for
the clinical potential of CBM and the development of a
novel computerized treatment that could help people with
depression to develop a more optimistic vision of the
future.
How might we develop a “cognitive vaccine”?
An example using mental imagery and
interpretation bias
Emily A. Holmes1
1
University of Oxford, United Kingdom
Introduction: How might we start developing a “cognitive
vaccine”? Given the need to improve mental health, it is of
interest to explore preventative clinical technologies informed
by cognitive science. Using cognitive bias modification
(CBM) of interpretation bias (CBM-I) may offer one such
option. That is, might training a more adaptive interpretation
bias promote resilience to a stressful event and thus protect
against later psychopathology? Our key focus has been CBM
to promote more positive interpretation bias using mental
imagery. However, in this talk we shall consider an interweave
of steps to translate research between the lab and the clinic.
Imagery CBM-I will be used as an example.
Objectives and Methodology: This talk will explore a
sequence of translational steps from laboratory experiments
in (i) healthy volunteers, (e.g. Holmes, Lang & Shah, 2009);
(ii) analogue samples with mild depressed mood (e.g. Pictet,
Coughtrey, Mathews, & Holmes, 2011); (iii) single case
series clinical studies (Blackwell & Holmes, 2010); (iv) small
clinical studies (Lang, Blackwell, Harmer, Davison & Holmes,
2011) to (v) early-phase clinical trials (Browning, Holmes,
Charles, Cowen & Harmer, 2012); (vi) randomised control
trials and so forth. The trajectory to translation also involves
an ongoing interweave of basic questions e.g. examining
related biases (Lang, Moulds & Holmes, 2009); differing
ages e.g. adolescents (Lothmann, Holmes, Chan, & Lau,
2011), psychopharmacological interaction (Browning, Grol,
Ly, Goodwin, Holmes & Harmer, 2011) and neuroimaging
(Browning, Holmes, Murphy, Goodwin, & Harmer,
2010).
Discussion and Conclusion: The field is young still at an
early stage. In this context this, we will discuss a cautious
interpretation bias towards optimism in the quest for a variety
of science-driven “cognitive vaccines”.
144
EABCT 2012
EABCT 2012
S62-01
Effectiveness of daily and prolonged Exposure
with Response Prevention (ERP) in resistant
inpatients with Obsessive-Compulsive Disorder:
An open trial
Davide Coradeschi2,3; Elena Mannelli3; Andrea Pozza2,3;
Giovanna Mengoli3; Davide Dèttore1,2,3
1
University of Florence, Italy; 2Miller Institute, Genoa/
Florence, Italy; 3“Poggio Sereno” Clinic, Fiesole, Italy
Introduction: Several studies have showed the
effectiveness of Exposure with Response Prevention
(ERP) in the inpatient residential treatment of resistant
Obsessive-Compulsive Disorder (OCD) (e.g. Stewart et al.
2005), but the effectiveness in reducing obsessive beliefs
was not investigated.
Objectives and Methodology: The aim of the present
study was to examine the clinical effectiveness of intensive
Exposure with Response Prevention in a group of
inpatients with resistant Obsessive-Compulsive Disorder,
using also obsessive belief domains as outcome. Thirtyfive inpatients (mean age = 33.63; SD= 8.74) with severe
OC symptoms (mean YBOCS = 27; SD= 7.04) were
treated with ERP consisting of two daily sessions (2,5
hours each one, five days a week) of Exposure in Vivo
and Response Prevention during a period of one month.
Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck
Depression Inventory (BDI-II), Beck Anxiety Inventory
(BAI) and Obsessive Beliefs Questionnaire (OBQ-87) were
administered at pre- and post-treatment.
Results: Results of Paired Samples t-tests showed
statistically significant reductions from pre- to posttreatment on obsessive-compulsive symptoms [t(34)= 8.11,
p< .001], on depressive [t(34)= 8.69, p< .001] and anxious
symptoms [t(34)= 8.80, p< .001]. Statistically significant
differences from pre to post-treatment were also observed
on all obsessive belief domains: respectively on Threat
Estimation [t(34)= 5.16, p< .001], Uncertainty Intolerance
[t(34)= 6.41, p< .001], Importance of Thoughts [t(34)=
4.52, p< .001], Control of Thoughts [t(34)= 8.11, p< .001],
Responsibility [t(34)= 4.46, p< .001] and Perfectionism
[t(34)= 6.22, p< .001].
Discussion and conclusions: These findings suggest
that Exposure with Response Prevention might affect also
vulnerability factors for resistant OCD, like obsessive belief
domains. Directions for future research are discussed.
145
62
Reducing analogue trauma symptoms by
computerized cognitive reappraisal training –
Finding a cognitive vaccine?
Marcella L. Woud1; Peggy Postma2; Emily A. Holmes3;
Bundy Mackintosh4;
1
Radboud University Nijmegen, The Netherlands; 2Private
Practice, Bishop’s Stortford, United Kingdom; 3University
of Oxford, United Kingdom; 4University of Essex, United
Kingdom
Introduction: Distressing intrusions are a hallmark of
posttraumatic stress disorder (PTSD). Moreover, there
is a strong association between types of appraisals
that follow the traumatic experience and the severity
of the disorder: Dysfunctional appraisal styles may
lead to further distressing intrusive memories and can
additionally contribute to other symptoms associated with
posttraumatic distress. An initial study by Woud, Holmes,
Postma, Dalgleish, and Mackintosh (2011) provided some
first evidence that cognitive bias modification appraisal
(CBM-A) training can reduce intrusive memories as well
trauma-related symptoms when applied immediately
after being exposed to an analogue, traumatic event (i.e.,
watching distressing films clips).
Objectives and Methodology: This study aimed to
investigate the potential preventative function of CBM-A
training. Therefore, participants first completed CBM-A
training and then had to watch distressing film clips.
Participants were trained to adopt a generally positive
or negative appraisal style using a series of scripted
vignettes. Outcome measures were collected pre and posttraining, and at one week follow-up.
Results: Participant in the positive CBM-A training
condition reported less intrusion distress at one week
follow-up compared to those in the negative CBM-A
training condition.
Discussion and Conclusion: Results indicate that
CBM-A training is also beneficial when it comes to the
prevention of trauma-related symptoms. Hence, there is
some first evidence for the clinical potential of CBM-A in
the context of preventing PTSD.
Symposium 62 - Resistant obsessivecompulsive disorder: Perspectives for
evaluation and treatment
Symposium
S61-05
S62-02
S62-03
Personality disorders comorbidity and obsessive
belief domains in the outcome of behavior
therapy for resistant obsessive-compulsive
disorder
Davide Coradeschi1; Elena Mannelli; Giovanna Mengoli;
Luciana Rotundo; Andrea Pozza; Tiziana Neri; Davide
Dettore2
1
Miller Institute, Genova, Italy; 2University of Florence,
Italy
Obsessive-compulsive disorder and inferential
confusion: a preliminary study on the italian
version of icq-ev
Annunziata Larosa1; Davide Coradeschi1; Davide Dèttore2
1
Miller Institute, Genova, Italy; 2University of Florence,
Italy
Symposium
62
Introduction: Evidence on Comorbid Personality
Disorders (CPD) as risk factors for a negative treatment
outcome in OCD is far from conclusive. Specific
dysfunctional obsessive beliefs might account for the
relationship between CPD and treatment response.
Objectives and Methodology: To investigate which belief
domains are more relevant for CPD in patients with OCD
and if CPD and belief domains predict treatment response
to behavioural interventions. 33 inpatients with severe
OCD (mean Y-BOCS= 27, SD= 7.30) completed exposure
with response prevention treatment consisting of two daily
sessions (2,5 hours each one, five days a week) during a
period of one month. Yale-Brown Obsessive-Compulsive
Scale (Y-BOCS), Obsessive Beliefs Questionnaire (OBQ87) and Structured Clinical Interview for DSM-IV Axis II
Personality Disorders (SCID-II) were administered at preand post-treatment.
Results: Independent t-tests showed that inpatients with
Axis II comorbidity had significantly higher scores at
pre-treatment on Uncertainty Intolerance [t(31)= - 2.37,
p< .05], on Threat Estimation [t(31)= - 2.07, p< .05]
and Perfectionism [t(31)= - 2.57, p< .05]. An Univariate
General Linear Model (GLM) with OC post-treatment
scores as dependent variable, Axis II comorbidity as a
fixed factor and obsessive belief domains at pre-treatment
as covariates was carried out. While controlling for all
independent variables, results showed that only Importance
of Thoughts at pre-treatment significantly and positively
predicted post-treatment scores on OC symptoms [t(31)=
- 2.66, β= 0.41, p< .05].
Discussion and conclusions: Future research should
examine how specific personality disorders are related to
obsessive belief domains. In contrast to previous research
(Keeley et al., 2008), our data suggest that CPD does not
predict therapy outcome; specific dysfunctional obsessive
beliefs are strong predictors of negative outcome.
Theoretical and clinical implications are discussed.
146
Introduction: Inferential Confusion is a particularly
relevant reasoning process involved in the development
and maintenance of Obsessive Compulsive Disorder
(OCD). The distrust of senses and inverse inference are
two core components of this kind of cognitive bias.
Objectives and Methodology: The aim of this study
was to test psychometric properties of the Italian version
of Inference Confusion Questionnaire-Expanded Version
(ICQ-EV) in Italian clinical (30 patients with OCD, 30
patients with other anxiety disorders) and non-clinical
subjects (120 subjects). Beck Depression Inventory-II
(BDI-II), Beck Anxiety Inventory (BAI), Italian version of
Inferential Confusion Questionnaire-Expanded Version
(ICQ-EV), Obsessive Beliefs Questionnaire (OBQ-44),
Padua Inventory (PI) and the Yale-Brown Obsessive
Compulsive Scale (Y-BOCS) were administered to all.
Results: Cronbach’s alpha for the ICQ-EV was 0.95
in the control group, 0.97 in the OCD group and 0.98
in the anxiety group. The eigenvalue for the first factor
was 13.26, which explains 44.21% of the variance.
The analysis of variance showed an overall significant
difference between the three groups (F(2,177)=45.29;
p<0.001). No significant differences were found between
the OCD and anxiety groups. Inferential Confusion scores
were significantly related to all obsessive-compulsive
symptoms. In particular, quite strong relationship (r=0.80)
were found with the ”Importance of Thoughts/Control of
Thoughts” subscale.
Discussion and conclusions: Italian version of ICQEV seems to show satisfactory reliability coefficients. The
results suggest a one-dimensional factor structure for this
version. The OCD group score was significantly higher
than non-clinical control group but was not significantly
different from the anxiety group. Results show that the
construct of Inferential Confusion is significantly related
with obsessive compulsive symptoms when controlling
for negative mood and anxiety states or for cognitive
domains.
EABCT 2012
Introduction: Few studies examined the cognitive
changes after exposure with ritual prevention and the
results found were inconsistent (Emmelkamp et al., 2002).
A possible explanation is that criteria for defining treatment
response based on comparisons between responders and
non-responders are nonspecific.
Objectives and Methodology: Using the methodology
of Jacobson & Truax (1991) for operationalizing clinical
significant change, we investigated if significant clinical
change could be more strongly related to and better
account for OC change than a nonspecific comparison
based on treatment response.
35 inpatients (mean age = 33.8; SD= 9.0) with severe OC
symptoms (mean YBOCS = 27; SD= 7.04) were treated
with ERP consisting of daily sessions (2,5 hours each one,
five days a week) of exposure in vivo with ritual prevention
during a period of one month.
Yale-Brown Obsessive-Compulsive Scale (Y-BOCS),
Beck Depression Inventory (BDI-II) and Obsessive Beliefs
Questionnaire (OBQ-87) were administered at the pre- and
post-treatment.
Results. Statistically significant differences between
responders’ and non-responders’ obsessive beliefs posttreatment scores were not found using independent t-tests.
One-way Anova with post hoc pairwise comparisons
applied to inpatients who achieved clinical significant
change, those who improved and those who achieved no
change showed that inpatients with significant clinical
change had significantly lower scores at post-treatment
only on Importance of Thoughts [F(2, 32) = 4.02, p <.05]
in comparison with those who achieved no change.
Discussion and conclusions. The reliable clinical
change produced by the behavioural intervention might be
related to a specific cognitive change in obsessive beliefs.
As showed across all studies, Importance of Thoughts/
Control of Thoughts is the only belief domain consistently
found as specific for obsessive-compulsive patients (e.g.
Tolin et al., 2006). Future directions for research/treatment
are discussed.
EABCT 2012
S63-01
Dyadic coping is more than just social support:
Implications for interventions
Guy Bodenmann1
1
University of Zurich, Switzerland
Dyadic coping is a concept that has been developed
in the early 1990ies. Since twenty years an increasing
body of research accumulates findings on the
significance of dyadic coping for relationship quality
and stability as well as health. Many studies show that
dyadic coping is a powerful predictor of relationship
functioning as well as well-being. Based on these
empirical studies, Bodenmann developed the Couples
Coping Enhancement Training (CCET) and the copingoriented couple therapy. Both approaches aim to
strengthen partner’s stress-related self-disclosure and
their dyadic coping. A number of studies reveal that the
approach is efficacious. However, more recent studies
show that dyadic coping is more than just spousal
support. Especially in the context of clinical groups,
common or joint dyadic coping seems to play an even
more important role. Well-being of the patient and the
partner are better when the couple copes together (joint
coping) whereas when the partner supports the patient.
The notion of “we-disease” or “we-ness” is presented
in this context and its relevance for clinical interventions
is discussed.
S63-02
Dyadic coping and stress recovery. Implications
for clinical work
Nathalie Meuwly1; Guy Bodenmann1; Janine Germann1;
Thomas N. Bradbury2; Beate Ditzen1; Markus Heinrichs3;
1
University of Zurich, Switzerland; 2University of
California, Los Angeles, USA; 3University of Freiburg,
Germany
Dyadic coping is known for its stress buffering effect.
Individuals who received support from their romantic
partner prior to a stressful task had decreased stress
reactivity in experimental studies. As receiving support
has long-lasting consequences for the individual,
physiological responses during stress recovery are of
particular interest. However, not all individuals seem
to benefit equally from dyadic coping. Adult attachment
has been suggested to moderate the effects of support on
health and well-being. The goal of the current study was to
147
63
Obsessive belief changes in patients with
resistant OCD after intensive behavior therapy:
An analysis based on different treatment
response criteria.
Andrea Pozza2,3; Davide Coradeschi2,3; Luciana Rotundo3 ;
Tiziana Neri3; Davide Dèttore1,2,3
1
University of Florence, Italy; 2Miller Institute, Genoa/
Florence, Italy; 3“Poggio Sereno” Clinic, Fiesole, Italy
Symposium 63 - Dyadic coping in clinical
practice
Symposium
S62-04
examine whether positive partner support would enhance
cortisol stress recovery. It was further hypothesized that
individuals with high levels in attachment anxiety or
avoidance would benefit less from support compared
to more securely attached individuals. Therefore, we
experimentally induced stress in either the woman or
the man in 123 heterosexual couples and observed the
dyadic coping process following stress. Results show
that stressed individuals recovered faster from stress the
more positive support they received from the partner. This
effect was decreased in highly anxious women. Contrary
to our expectations, there was no moderating effect for
attachment avoidance. These findings suggest that,
particularly in women, attachment might modulate the
effects of partner support on physiological stress recovery.
Clinical implications of findings are discussed.
S63-03
Symposium
63
Dyadic coping, self-esteem and depressed mood
in adolescents’ romantic relationships
Christina Götz1; Anne Milek1; Fridtjof W. Nussbeck1; Guy
Bodenmann1
1
University of Zurich, Switzerland
Empirical findings suggest that parents and peers influence
the development of self-esteem in childhood and early
adolescence. However, in late adolescence the importance
of romantic relationships compared to other relationships
(parents/peers) is increasing while the influence of parents
fades. Adolescents involved in romantic relationships are
therefore less likely to seek support from their parents, but
more likely to turn to their partner for getting assistance in
stressful situations. Providing and getting support in romantic
relationships is an interactive, dynamic and reciprocal process
as described in Bodenmann’s systemic-transactional theory
of dyadic coping (see Bodenmann, 2005). Accordingly, in
adolescence partner’s positive support and common dyadic
coping become increasingly important for one’s well-being
and self-esteem.
This study explores the impact of perceived positive and
negative dyadic coping (from partner, parents and best friend)
on self-esteem and depressive mood in adolescent romantic
partners in both partners of adolescent couples (N=100).
Multivariate analysis procedures are used to investigate how
parents’, peers’ or partners’ support covaries with adolescent’s
self-esteem and depressed mood, taking into account the
dyadic structure of the data.
Results indicate that perceived dyadic coping from the partner
is associated with own self-esteem and less depressed
mood. Parents’ support seems to be less predictive for the
outcome measures and also peer support is less important
than partner’s dyadic coping. Implications of the results for
prevention and practice are discussed.
148
S63-04
Dyadic Coping and Emotion-Focused Approaches
for Couple Therapy
Ana Vedes1
1
University of Lisbon, Portugal
This contribution aims to link the concept of dyadic
coping with emotion-focused therapy. It considers the
unique contributions of the field of intimate relationships
from (a) dyadic coping research and interventions (e.g.
Bodenmann, 2007, 2010; Bodenmann & Randall, 2011)
and (b) emotion-focused approaches for couple therapy
(e.g, Greenberg & Johnson, 1988; Johnson, 2004;
Goldman & Greenberg, 2009). After an analysis of the
common and specific features of each approach and a
presentation of the different therapeutic techniques, a
discussion about a possible integration of techniques
follows with the purpose to further enhance couple’ therapy
efficacy and effectiveness.
S63-05
Improving relationship quality and skills by a
DVD approach
Peter Hilpert1; Guy Bodenmann1; Fridtjof W.Nussbeck1;
Thomas N. Bradbury2
1
University of Zurich, Switzerland; 2University of
California, USA
Marital distress or divorce has harmful effects on physical
and psychological health and partners’ life satisfaction.
Thus prevention of relationship distress is an important
objective. Although an increasing body of research
illustrates the efficacy of such programs, it also reveals
numerous barriers for couples to participate in prevention
programs. An option to overcome many barriers might
be a DVD-based prevention approach. 320 couples were
randomly assigned to one of three treatment conditions
(DVD group without any further support; DVD group with
telephone coaching, waiting list control group). Couples
completed questionnaires at pre-test, post-test and at
follow-ups at 3 and 6 months after completion of the
intervention. Couples belonging to the two intervention
groups showed significant improvement in relationship
satisfaction and skills (dyadic coping, communication)
and reduced intensity of their arguments in comparison
with the waiting list control group. As expected, subjects
with lower skills reported better improvement. The results
show that a DVD approach may be a valuable option to
improve relevant relationship skills.
EABCT 2012
Brauchen Menschen mit Außergewöhnlichen
Erfahrungen eine außergewöhnliche
Behandlung?
Martina Belz1
1
Universität Bern, Switzerland
Menschen berichten schon immer und überall auf der Welt
über außergewöhnliche oder anomale Erfahrungen, die
gewöhnlich dem Bereich der Parapsychologie zugeordnet
werden. Damit sind zum Beispiel spontan auftretende
Wahrträume, Spuk, Hellsehen oder Gedankenübertragung
gemeint, aber auch Phänomene, die im Zusammenhang
mit Praktiken wie Glasrücken und Pendeln berichtet werden
oder Erlebnisse, die im Zusammenhang mit meditativen
Praktiken, nach dem Kontakt mit Medien, alternativen
Heilern und Hellsehern oder nach der Teilnahme an
Veranstaltungen der Esoterikszene auftreten – Erfahrungen
und Themen, die Menschen seit Jahrhunderten faszinieren.
Der Vortrag gibt einen Überblick über die Vielfalt dieser
Erfahrungen und zeigt, wie diese Erfahrungen unter
Berücksichtigung der Erkenntnisse der wissenschaftlichen
Psychologie verstanden und verarbeitet werden können.
Schlüsselbegriffe:
Aussergewöhnliche
Erfahrungen,
anomale Phänomene, Parapsychologie
S64-02
Körperpsychotherapie - Was ist das?
Christina Bader-Johansson1
1
Praxis für Körperpsychotherapie, Wollerau, Switzerland
Die Körperpsychotherapie gehört zu den ältesten
Richtungen der modernen Psychotherapie. Ende
des 19. Jahrhunderts erforschte Pierre Janet,
Psychologieprofessor in Paris, bereits intensiv GeistKörper-Zusammenhänge. Zusammen mit Wilhelm Reich,
ein Schüler von Sigmund Freud, werden die beiden als
Pioniere in der Entwicklung der Körperpsychotherapie
betrachtet. Die Körperpsychotherapie stützt sich auf
eine fundierte theoretische Forschung in den Bereichen
Biologie, Anthropologie, Ethnologie, Physiologie,
Neuro-psychologie, Neurobiologie, Neonatalogie und
Entwicklungspsychologie. Sie hat ihre Wurzeln sowohl
in der Tiefenpsychologie als auch in der humanistischen
Psychologie. Eine Vielfalt von diagnostischen und
therapeutischen Techniken wird in der Therapie eingesetzt,
z.B. Atmungs- Berührungs- und Bewegungstechniken,
sowie auch verschiedene Gesprächsmethoden, die eine
EABCT 2012
S64-03
Aus der Praxis der Hypnotherapie: Kontrolle
verlieren und......sie (wieder-) gewinnen
Thomas Villiger1
1
Private Practice, Biel, Switzerland
Es handelt sich um einen Beitrag zur hypnotherapeutischen
Praxis bzw. zum Einsatz therapeutischer Hypnose am
Beispiel von Zwangsfragen und Tics (inkl. Videovignette).
Klinisches Erfahrungswissen zeigt: Personen, die sich
mit diesen Fragen auseinandersetzen, stellen die eigene
Wahrnehmung massivst in Frage und erleben sich vielfach
hin - und hergerissen - in hoher Ambivalenz zwischen Chaos
und Erstarrung. Gleichzeitig erscheint die Symptomatik
als ein Lösungsversuch: Wie weiss man, dass man sicher
ist, bei dem, was man wahrnimmt ? Die vorgestellte
Intervention, angewendet in mehreren therapeutischen
Kooperationen, ist eine hypnotherapeutische Dissoziation.
Sie vertieft und schärft die eigene Wahrnehmung z.B. von
Körperbewegungen, womit das Vertrauen in die eigene
Wahrnehmung bedeutsam gestärkt und den Einladungen
des „ungebetenen“ Gastes Zwang wirksam begegnet
werden kann.
Diese Fragen führen zur Dialektik von Veränderung Fixierung, die letztlich viel mit Sinnfragen zu tun hat, was
z.B. Daniel Spörris Kunstwerke eindrücklich darstellen.
Ziel: Die Teilnehmer/innen sollen anhand der
Falldarstellung Anregungen für die eigene Praxis
mitnehmen können.
149
64
S64-01
bindungsstärkende Interaktion unterstützen. Die Therapie
zielt darauf ab, einen lebensbejahenden Umgang mit
sich selbst und den Mitmenschen zu entwickeln. Die
zugrunde liegende Annahme für die Therapie ist, dass
der Körper die gesamte Person spiegelt und dass eine
unteilbare funktionelle Einheit zwischen “mind”/Psyche/
Geist und Körper besteht. In der Therapie fragen wir uns
„Welchen Einfluss hatten und haben Lebensereignisse auf
unsere somatische und psychische Befindlichkeit?“ Der
Körperausdruck wird als eine Ressource betrachtet, die
eine biologisch unentwickelte Bewegung fördern kann
und dadurch den therapeutischen Prozess zusammen
mit reflektierenden Gesprächen voranbringen kann.
Somit werden physiologische Schutzreaktionen in ihren
chronologischen und psychischen Kontexten verstanden,
bearbeitet und mit neuen Lösungen attribuiert. Aus
einem unbewussten Affekt entwickelt sich eine bewusste
Emotion, die im Körper wahrgenommen wird und verbal
kommuniziert werden kann. Somit erhalten Grenzen
eine wichtige Bedeutung in der zwischenmenschlichen
Interaktion.
Symposium
Symposium 64 - Untypische Methoden in
der VT
S64-04
Symposium
65
Verhaltenstherapie und Arbeit mit Träumen
Claude Haldimann1
1
Private Practice, Bern, Switzerland
Verhaltenstherapie und Träume! - Eine unheilige Allianz? Ein Kniefall gegenüber der Psychoanalyse? - Unabhängig
von der wissenschaftlichen Fragestellung, wie Träume
entstehen, zu erklären und zu interpretieren sind, schildern
Menschen, die über sich und ihr Leben nachdenken - also
auch in Verhaltenstherapien - von Traumgeschehen in
der Nacht. Dies muss Grund genug sein, dass sich auch
Verhaltenstherapeuten überlegen sollten, ob diese Träume
in ihrem Paradigma nicht sinnvoll eingesetzt werden
bzw. das kognitiv-verhaltens-therapeutische Vorgehen
unterstützen könnten.
Aus der kognitiven Ecke der Verhaltenstherapie sind
in den letzten 15 Jahren einige viel-versprechende
Vorschläge publiziert worden, wie Träume ähnlich wie
dysfunktionale Gedanken oder verzerrte Wahrnehmungen
bearbeitet werden könnten. Leider sind diese bis anhin
wenig bekannt. Dies hängt sicher auch damit zusammen,
dass Verhaltenstherapeuten wenig Kenntnisse haben, mit
welchen Methoden mit und an Träumen gearbeitet werden
könnte. Eine gewisse Scheu besteht vielleicht auch, weil
diese aus tiefenpsychologischen, körperorientierten
und gestalttherapeutischen Ansätzen entliehen werden
müssen.
Ein weiteres Feld zur Anwendung der Arbeit mit Träumen
eröffnet sich im Bereich der Schematherapie und
insbesondere in der Modi-Arbeit. Auf der Subjektebene
bearbeitete Träumekönnen wichtige erlebniszentrierte
Informationen über die Modi als Teile der Person geben.
Das Referat möchte aus der Sicht des Praktikers einen
Überblick über die obigen Vorgehensweisen geben und
diese mit einigen Fallbeispielen illustrieren.
150
Symposium 65 - Trauma
S65-01
EMDR
Pascale Nguyen-Vela1
1
Private practice, Fribourg, Switzerland
Présentation
de
l’EMDR
comme
méthode
psychothérapeutique intégrative utilisant le modèle de
Traitement adaptatif de l’information. Exemple d’une séance
de traitement avec un protocole standard: formulation de
la cible à partir d’un souvenir explicite et traitement de
l’expérience traumatique jusqu’à une résolution adaptée.
S65-02
La rescénarisation en imagerie des souvenirs
traumatiques
Grazia Ceschi1
1
University of Geneva, Switzerland
La psychopathologie cognitive contemporaine considère
que les «images mentales» influencent le développement
et le maintien de nombreuses troubles émotionnels dont, en
prime instance, l’Etat de Stress Post-Traumatique (ESPT).
Normalement, les images du traumatisme (« flashbacks
») apparaissent dans le champ de conscience de manière
involontaire et répétitive. Ces images intrusives peuvent
être considérées comme des souvenirs autobiographiques
reliés aux caractéristiques perceptives et émotionnelles
du traumatisme d’origine. Bien que ces images
soient rappelées par des processus de récupérations
involontaires, elles peuvent également faire l’objet d’une
récupération mnésique volontaire. Par rapport à un récit
verbal, la génération volontaire d’un souvenir traumatique
imagé tend à amplifier les émotions ressenties par la
personne. En accord avec les idées princeps d’A. Beck,
il est actuellement postulé que ces cognitions « chaudes
» ouvrent la voie au changement psychologique. Ainsi,
depuis une dizaine d’années, de nombreuses interventions
psychologiques fondées sur l’imagerie mentale ont
vu le jour. Ces techniques d’imagerie ont récemment
bénéficié d’une attention toute particulière (e.g., numéro
spécial de Journal of Behavior Therapy and Experimental
Psychiatry, 2007) grâce, en bonne partie, à l’efficacité de
la « rescénarisation en imagerie » (RI). La RI peut être
considérée comme une technique de « réinscription »
des souvenirs autobiographiques stockés en mémoire. En
cela, elle permet de modifier les souvenirs traumatiques
et les croyances dysfonctionnelles qui y sont associées.
Ma communication présentera les grandes lignes de cette
technique d’intervention (pouvant être intégrée comme
EABCT 2012
L’investigation des troubles dissociatifs
complexes à l’aide du SCID-D
Olivier Piedfort-Marin1
1
Institut Romand de Psychotraumatologie, Lausanne,
Switzerland
Le Trouble dissociatif de l’identité et le Trouble dissociatif
non spécifié de type 1 sont des troubles dissociatifs
complexes et fréquents. Dans une étude récente réalisée
en Suisse alémanique, on note une prévalence de
respectivement 7.5 % et 6.3 % dans un échantillon
de 160 patients ambulatoires (Mueller-Pfeiffer & coll.,
under press). Ces troubles d’origine traumatique peuvent
être très invalidants et s’accompagnent souvent d’autres
troubles des axes I et/ou II qui sont souvent à l’origine de
la demande de consultation. Ces symptômes très divers,
non spécifiques du trouble dissociatif, peuvent être en
lien avec celui-ci. Le patient peut ne pas être conscient
des symptômes spécifiques du trouble dissociatif ou les
cacher au thérapeute, de peur de passer pour un « fou ».
En particulier lorsque les patients viennent consulter pour
traiter des traumatismes, il convient d’évaluer l’éventuelle
présence d’un trouble dissociatif, car cela aura des
conséquences majeures dans le choix du traitement. Cette
présentation fera dans un premier temps un résumé des
indices de la présence possible d’un trouble dissociatif
complexe. Ensuite seront présentés les domaines
d’investigation pour déceler un éventuel trouble dissociatif
complexe. Pour cela nous nous baserons sur le SCID-D,
entretien semi-structuré développé par Steinberg (1994)
dont la traduction française non encore validée a le mérite
d’exister. Le SCID-D propose 5 domaines d’investigation
: amnésie, dépersonnalisation, déréalisation, confusion
de l’identité et altération/fragmentation de l’identité. Nous
passerons en revue les principaux items du SCID-D.
S65-04
Quand l’accident devient traumatisme
Jean Savoy1
1
Clinique Romande de Réadaptation, Sion, Switzerland
La relation entre accident et traumatisme psychique
n’est pas linéaire. Ce lien est discuté à travers quelques
données de la littérature et l’expérience dans une clinique
de réadaptation pour patients accidentés. A travers
EABCT 2012
S65-05
Travailler avec les personnes victimes de
violence conjugale ou d’abus sexuels
Tania Knoch Kasme1
1
Centre de Consultation LAVI, Geneva, Switzerland
Les personnes victimes d’agressions qui se prolongent
dans le temps présentent fréquemment des troubles
complexes. Le contexte d’impuissance et de peur perdurant
peut amener les personnes traumatisées à « perdre la
parole ». Les professionnels sont amenés à faire une prise
en charge qui tienne compte de la globalité de la situation
de la victime. L’évaluation clinique sera complétée par une
évaluation sociale et juridique et inclura également les
retentissements d’une procédure pénale sur la victime. La
prise en charge des personnes traumatisées visera d’abord
la stabilisation émotionnelle et la ré-émergence de la parole
niée de la victime. Le travail sur les ressources aura pour but
le recouvrement de l’autonomie et de l’auto-détermination.
Retrouver la liberté et la capacité de décider sont donc des
objectifs primordiaux et demande de la part du thérapeute de
ne pas interférer dans les choix et décisions de la personne
mais de lui offrir un soutien et une prise de recul. Le travail
thérapeutique exige une attention accrue à la stabilisation
émotionnelle et appelle à l’intégration de différentes
stratégies thérapeutiques: la psychoéducation, la gestion de
l’anxiété, la restructuration cognitive, les approches comme
le mindfulness et le travail en imagination sont autant de
techniques qui visent un sentiment d’apaisement et de
centrage sur soi, et posent les conditions indispensables
pour une future exposition au souvenir traumatique. Offrir
un accueil ré-humanisant, mettre en mots les émotions,
aider à accepter le vécu, accompagner dans le processus de
deuil, sont les composantes du travail auprès des victimes
de violence conjugale et d’abus sexuels sur le chemin de la
réparation de leur dignité et leur santé mentale.
151
65
S65-03
quelques vignettes cliniques, les principaux ingrédients
favorisants le traumatisme psychique sont illustrés, ainsi
que l’expression symptomatique variée du trauma et les
principaux axes thérapeutiques. Une meilleure détection
du traumatisme psychique est souhaitable, pour aller vers
un traitement spécifique et offrir des meilleures chances
d’évolution d’un trouble à fort risque de chronicisation et
entraînant des conséquences négatives considérables au
niveau personnel et social.
Symposium
module « stand alone » au sein de toute prise en charge)
et passera en revue les principales études de validation
de cette méthode fondée sur les plus récentes théories
cognitives de la mémoire autobiographique.
Symposium 66 - Dysfunctional cognitive
processes across psychopathologies
S66-01
Symposium
66
Desire Thinking across the Continuum of
Drinking Behaviour
Gabriele Caselli1,2; Marcantonio M Spada1
1
London South Bank University, United Kingdom; 2Studi
Cognitivi Psychotherapy School and Research Institute,
Italy
Introduction: Desire thinking is a voluntary cognitive
process involving verbal and imaginal elaboration of a
desired target. Recent research has highlighted the role
of desire thinking in predicting addictive behaviours
independently of other psychological antecedents
including negative affect and craving.
Objectives & Methodology: The goal of this research
project was to explore the role of desire thinking across
the continuum of drinking behaviour. A sample of alcohol
dependent drinkers (n=43), problem drinkers (n=59), and
social drinkers (n=68) completed self-report instruments
of desire thinking, negative affect, craving and drinking
behaviour.
Results: Analyses revealed that alcohol dependent
drinkers and problem drinkers scored higher than social
drinkers on imaginal prefiguration and that alcohol
dependent drinkers scored higher than problem drinkers
which in turn scored higher than social drinkers on verbal
perseveration. A logistic regression analysis indicated that
verbal perseveration was the unique significant predictor
of classification as an alcohol dependent drinker.
Discussion & conclusions: The findings suggest that
desire thinking may be a risk factor across the continuum
of drinking behavior and that treatment may benefit from
targeting specifically this cognitive process.
S66-02
Rumination and craving in problem drinking: An
experimental design
Antonella Gemelli1,2; Gabrielle Caselli2,3, Flaviano
Canfora2, Annamaria Lugli2, Sara Querci2
1
CEIS, Modena, Italy; 2Studi Cognitivi Psychotherapy
School and Research Institute, Italy; 3London South Bank
University, United Kingdom
Introduction: A series of studies has shown the
central role of rumination in maintaining alcohol abuse
disorders and in increasing the risk of relapse even after
a psychotherapeutic and pharmacological treatment that
was not operating on these variables. A recent research has
152
demonstrated that a general tendency to ruminate predicts
category membership as a problem drinker independently
of depression. Moreover, both in clinical sample and in
community sample, tendency to ruminate predicts alcohol
use independently of depression.
Objectives and Methodology: This study aims to
assess whether the induction of rumination has significant
effect on increasing the experience of craving in patients
with a diagnosis of alcohol related disorder (DSM-IVTR) compared to a sample of problem drinkers and a
sample of social drinker. After an initial assessment where
participants were subject to some short evaluations (check)
of dependent variables in mood, craving, self-perception of
control on their own behavior, the experimental condition
consisted on induction experimental tasks respectively of
rumination thought and distraction.
Results: Separate 3 (Group) x 2 (Condition) x 2 (Time)
Analyses of Variance (ANOVAs) were used to test
the hypotheses relevant to each dependent variable.
Preliminary results suggest a significant effect of
rumination on craving.
Discussion & conclusion: Rumination, thorough a
direct and indirect relationship, could play a central role
as residual symptom, predicting level of craving, relapse
and the level of alcohol use after treatment.
S66-03
Self-Discrepancy monitoring and its impact on
depressed mood: an experimental study
Chiara Manfredi1; Gabrielle Caselli1,2, Alina Decsei-Radu3,
Francesca Fiore1, Sara Querci1, Sara Sgambati1, Daniela
Rebecchi1, Daniela M. Ruggiero1, Sandra Sassaroli1
1
Studi Cognitivi Psychotherapy School and Research
Institute, Italy; 2London South Bank University, United
Kingdom; 3University or Oradea, Romania
Introduction: Little is known about the cognitive
attentional response to positive stimuli in depression.
Self-discrepancy monitoring refers to the voluntary reorientation of attention towards possible discrepancies
between ideal and actual scenarios, even in a positive
situation.
Objectives and Methodology: The goal of this study
was to explore the impact of discrepancy monitoring on
levels of mood and the beliefs that people hold about
the utility and harm of this thinking process. Two clinical
and two non-clinical samples were recruited from Italy
and Romania, were asked to focus on a past positive
experience and then were randomized into two induction
tasks. The experimental condition consisted on focusing
on discrepancies between personal goals and the positive
experience, while the control condition consisted on
focusing on the situation description.
EABCT 2012
Love addiction and cognitive processes
Francesca Fiore1; Giovanni M. Ruggiero1, Sandra
Sassaroli1
1
Studi Cognitivi Psychotherapy School and Research
Institute, Italy
Introduction: Love Addiction is a mental disorder that
recently aroused the interest of clinicians and researchers.
It is into the broader category of New Addictions, and
include all forms of dependence that does not involve
the use of any chemicals. The object actually is a loved
person elusive, always engaged in something more
important. Moreover, love addicted are unable to choose a
reliable partner, and hence may be involved in destructive
relationships with violent and aggressive people that
trigger addiction. The scientific literature on this topic
is insufficient. Given that many people suffer from this
disorder, we wondered if they have the same cognitive
processes present in other addiction.
Objective: This study explored the relationship between
cognitive process, such as rumination and worry,
anxiety pathology and love addiction using a correlation
methodology. In addition, we tested whether particular
type of attachment style were related to love addiction and
if cognitive processes moderate this relatioship.
Method: 104 non clinical individuals, matched for sex
and age, participated to this experiment and completed a
battery of questionnaires.
Results: Analyses showed a significant relation betwenn
rumination, love addiction and depression, and we
obtained a path model in where dismissing attachment
influenced rumination process and love addition.
Conclusions: This finding suggests that love addicted
are characterized by cognitive processes akin to other
addiction disease.
EABCT 2012
Ruminative thought and dysregulated behavior
in Borderline Personality Disorder
Francesca Martino1,2; Gabriele Caselli2; Marco Menchetti1,3;
Domenico Berardi1,3,Sandra Sassaroli2
1
Bologna University, Italy; 2Studi Cognitivi, Cognitive
Psychotherapy School and Research Institute, Italy;
3
Bologna Mental Health Department, Italy
Background: Emotional dysregulation and uncontrolled
behavior are central features of BPD (Linehan 1993).
Some authors (Selby et al. 2008) suggest that emotional
instability may be intensified by rumination, leading to
dysregulated behavior (including self-harm, substance
use, binge eating, and aggressive behavior) as subsequent
distraction from negative affect. Anger rumination, in
particular, has been shown to increase and maintain
feelings of anger, physiological arousal and to lead
aggressive behavior (Denson et al 2011, Baer et al. 2011).
Aim: the aim of the study is to assess anger rumination
in clinical population (BPD and other PDs) and in healthy
volunteers in order to evaluate its role in dysregulated
behaviors, such as aggression and self-harm, in relation
to impulsiveness.
Methods: Patients, admitted to the Mental Health
Community Centre of Bologna and to the Cognitive
Psychotherapy and Research Centre of Milano, and
university students, are evaluated through psychometric
instruments on clinical variables: personality, anger
rumination, self-harm, emotional dysregulation,
aggressive behavior and impulsiveness.
Results: The role of ruminative thought will be investigated
through correlation and regression analysis. Preliminary
data will be showed and discussed.
Discussion & Conclusions: results will show how anger
rumination may be a relevant residual symptom that may
increase the risk of dysregulated behavior in borderline
personality disorder.
References
Linehan, M. M. (1993). Cognitive behavioral treatment of borderline
personality disorder. NY: Guilford
Selby, E.A., Anestis, M.D., Joiner, T.E. (2008). Understanding the
relationship between emotional and behavioral dysregulation:
Emotional cascades. Behaviour Research and Therapy, 46, 593-611.
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66
S66-04
S66-05
Symposium
Results: Findings showed that discrepancy monitoring
leads to a significant decrease in mood over a short term
period both Italian and Romanian samples and across the
continuum of depressive symptoms severity.
Discussion: Self-discrepancy monitoring response
to positive stimuli tends to decrease current mood
independently from the initial level of depressive symptoms
and it seems an universal trigger of emotional distress.
Conclusion: These findings suggest that assessing
discrepancy monitoring may be useful to identify a
potential maladaptive attentional strategy that could have
an impact on low mood and negative automatic thoughts,
independently from the diagnosis of depression. Results
about the metacognitive beliefs shown by depressed and
non-depressed people will be presented and discussed.
Symposium 67 - Therapygenetics:
Combining experimental and genetic
methods to inform psychological
interventions
S67-01
Symposium
67
Attention to Threats and Combat-Related
Post-Traumatic Stress Disorder Symptoms:
Prospective Associations and Moderation by the
Serotonin Transporter Gene
Yair Bar-Haim1 ; Ilan Wald1
1
Tel Aviv University, Israel
Introduction: Combat exposes soldiers to a range of
potentially traumatic events and constitutes a major risk
for posttraumatic stress disorder (PTSD). This study was
designed to investigate the role of the interplay among
genes, threat processing, and combat exposure, in the
development of PTSD symptoms.
Objective and Methods: Participants in this longitudinal
prospective study were 1084 first-tier Israeli Defense Force
infantry soldiers. Repeated-measurements over a one-year
period were collected: Baseline and pre-deployment data
collected in training camps; deployment data in combat.
Main outcome was post-combat PTSD symptoms. Primary
predictors were polymorphism in the serotonin transporter
gene (5HTTLPR), combat exposure, and threat-related
attention bias.
Results: Soldiers developed threat vigilance during
combat deployment that was moderated by combat intensity
(p<0.0001). Additionally, threat-related attention bias
interacted with combat exposure to predict risk for PTSD
(p<0.05). Bias towards threat at recruitment (p<0.0005)
but bias away from threat just before deployment
(p<0.05) predicted post-combat PTSD. Moreover, threatrelated attention effects were moderated by genetic and
environmental factors in predicting risk for PTSD. Linear
regression in a structural equation modeling framework
indicated that attention bias interacted with 5HTTLPR
genotype in high-combat-exposure soldiers, such that
highly-exposed soldiers with both attention vigilance and
low-efficacy 5HTTLPR genotype exhibited particularly low
levels of PTSD symptoms (p<0.01).
Discussion and Conclusion: Combat-induced changes
in environmental danger interacted with genetic and
neuro-cognitive threat processing functions to account
for a considerable amount of the variance in vulnerability/
resilience to PTSD. Understanding these associations
informs research on novel attention bias modification
therapeutics and prevention of PTSD.
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S67-02
Variation on the serotonin transporter gene
predicts sensitivity to cognitive bias modification
interventions
Elaine Fox1
1
University of Essex, United Kingdom
Introduction: Attention bias modification (ABM)
procedures have been shown to modify biased attention
with important implications for emotional vulnerability
and resilience. The reduction of “toxic” biases by means
of ABM, for instance, is a potential intervention for the
treatment of anxiety disorders. A separate line of Geneby-Environment (G X E) interaction research indicates
that so-called “vulnerability genes” may be better viewed
as “plasticity” or “adaptability” genes. The hypothesis
is that these genes may render some individuals more
susceptible to environmental influences for better and for
worse.
Objectives and Methodology: The objective was to
investigate whether common variation on the serotonin
transporter gene, was associated with differential
sensitivity to an ABM intervention. We used a randomized
placebo-controlled ABM procedure in a sample of 116
healthy adults. One group received ABM designed to
induce an attentional bias toward negative material, while
the other group was trained to orient towards positive
pictures. Individuals with low and high expressing forms
of the 5-HTTLPR were compared.
Results: Those with a low expression form (S/S, S/Lg, or
Lg/Lg) of the 5-HTTLPR gene (often considered a “risky
allele) developed stronger biases for both negative and
positive affective pictures relative to those with the high
expression (La/La) form of the gene.
Discussion: These results provide evidence that
variation on a common gene is associated with differential
sensitivity to a cognitive intervention. These results show
that genetic variation influences who will benefit most
(and least) from therapeutic interventions, adversity and
supportive environments.
Conclusion: Combining advances in molecular genetics
with advances in cognitive psychology provides an
important first step in building an evidence base for the
development of individually tailored therapies.
EABCT 2012
Cognitive Behaviour Therapy for child anxiety
disorders: Genetic and clinical predictors of
treatment response
Kathryn Lester1
1
King’s College London, United Kingdom
Introduction: CBT is the treatment of choice for child
anxiety disorders, and is effective in around 60% of
cases. Poor treatment prognosis is associated with
greater symptom severity, parental psychopathology
and comorbid mood disorders, all of which could reflect
genetic influence. The role of genetic markers in predicting
response to CBT has received almost no attention to date.
Objectives and Methodology: 379 children (6-13 years)
undergoing CBT were recruited from Reading, UK and
Sydney, Australia. DNA was extracted from buccal-cells.
CBT response was defined using diagnostic interview. We
explored 2 genetic markers as predictors of CBT response:
the serotonin transporter polymorphism (5HTTLPR) and
the nerve growth factor rs6330 polymorphism. The short
(S) allele of the 5HTTLPR increases risk for internalizing
disorders in high stress environments, but has the opposite
effect under low stress, and thus may make individuals
more likely to benefit from a positive environment. NGF
rs6330 has been associated with anxiety and is implicated
in synaptic plasticity and response to stress. We also test
symptom severity, comorbid mood disorders and parental
psychopathology as predictors of CBT response.
Results: For 5HTTLPR, children with the SS genotype
were significantly more likely to respond favorably
to CBT than those carrying a long allele (78 vs. 58%
remitted). For NGF, children with 1 or more copies of the
T allele responded more favorably (TT: 77; CT: 64; CC:
53% remitted). Clinical measures only weakly predicted
CBT response when modeled concurrently with genetic
predictors.
Discussion and Conclusion: Knowing an anxious
child’s genetic makeup for NGF rs6330 and the 5HTTLPR
has predictive power for treatment prognosis, above and
beyond clinical predictors. This information could be
valuable in helping to decide whether a child is likely to
benefit from CBT alone or whether an enhanced treatment
is required.
The Twins Wellbeing Intervention Study (TWIST):
A genetically sensitive online intervention
Claire M.A. Haworth1; Claire Palmer1; Kristin Layous2;
Katherine S. Nelson2; Katherine Jacobs Bao2; Sonja
Lyubomirsky2; Robert Plomin1
1
King’s College London, United Kingdom; 2University of
California, Berkeley, USA
Introduction: Simple activities including performing acts
of kindness and writing gratitude letters have been shown
to increase wellbeing, but some individuals improve more
than others.
Objectives and methodology: Using an online wellbeing
intervention with a representative sample of UK twins, we
aimed to investigate the role of genes and environments
in explaining individual differences in response to these
wellbeing interventions. Twins and their parents logged onto
the TEDS website once a week for 9 weeks: providing data for
baseline, three weeks of control tasks, 3 weeks of wellbeing
interventions, and a follow-up assessment at week 9.
Results: Genetic influences on wellbeing increased
from 48% at baseline to 80% at the 9-week followup assessment. Shared environmental influences were
important for wellbeing at baseline, but showed no influence
by the follow-up. Finally, genetic influences explained 75%
of the individual differences in the change in wellbeing in
response to the intervention.
Discussion: Embedding an intervention within a twin
study allows the investigation of the role of both genetic
and environmental influences on individual differences
in intervention response. Genetic factors explained
most of the differential susceptibility to this behavioural
intervention.
Conclusion: Genetic (and environmental) influences are
dynamic; they can change in response to environmental
interventions. In this study, genetic influences were the most
important factor in explaining why some individuals gained
more from the intervention than others. Future work should
focus on these biological pathways to allow us to understand
how behavioural interventions get under the skin and into
the brain. The ultimate goal is to design personalised
interventions that overcome genetic (and environmental)
weaknesses and build upon genetic and environmental
strengths, creating positive gene-environment interactions.
EABCT 2012
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S67-04
Symposium
S67-03
Symposium 68 - The efficacy of Compassion
Focused Therapy
S68-01
Symposium
68
Shame, Self-Criticism and Self-Compassion in
Eating Disorders
Ken Goss1; Paul Gilbert2
1
Coventry Eating Disorder Service, Coventry, England;
2
University of Derby, United Kingdom
This presentation will explore the role of shame, selfcriticism and self- compassion in eating disordered
population, including Anorexia and Bulimia Nervosa,
ENDOS, Binge Eating Disorder and adults who are obese
and seeking treatment for weight loss.
Shame and self-criticism are very high across these
populations. A model for understanding how this may
impact on the aetiology, maintenance and treatment will
be introduced, and data exploring these emotions in
eating disorders will be presented. The development of
self-compassion as a way of addressing shame and selfcriticism, and supporting patients though the process of
therapeutic change during recovery from an eating disorder,
will be discussed. Data regarding treatment outcome
for a group therapy that targets the development of selfcompassion (Compassion Focused Therapy for Eating
Disorders) will be presented.
S68-02
S68-03
Exploring change processes in Compassion
Focused Therapy in Psychosis: Results of a pilot
randomized controlled trial
Christine Braehler1,2; Andrew Gumley2; Janice Harper1;
Sonia Wallace1,2; Paul Gilbert3
1
NHS Ayrshire & Arran, United Kingdom; 2University of
Glasgow, United Kingdom; 3University of Derby, United
Kingdom
Emotional recovery after psychosis is hindered by
internal and external threats including feelings of shame,
stigma, entrapment and social isolation. Compassion
focused therapy (CFT) aims to stimulate capacities for
soothing and affiliation to self and others as a way to
regulate the threat system. This paper will report on a
prospective, randomized, open-label, blinded end point
evaluation (PROBE) design was used to evaluate the
acceptability, feasibility and change processes associated
with group CFT for psychosis. Relative to TAU, CFT was
associated with greater observed clinical improvement
and significant increases in narrative compassion.
Significant correlations between an increase in narrative
compassion and reductions in depression and perceived
social marginalization were found in the CFT group. This
is the largest study of CFT in psychosis to date and the
first randomized controlled evaluation of CFT. Findings
support the acceptability, feasibility and change processes
associated with reduced depression following CFT making
it a safe, acceptable, promising and evolving intervention
for promoting emotional recovery from psychosis.
Design And Trial Of A Transdiagnostic Group
Therapeutic Manual Based On Compassion
Focused Therapy Principles
Bodil Andersen1; Peter Hørslev Rasmussen1
1
Kognitiv Center Fyn, Odense, Denmark
Some patients suffering from shame and self attacking
behaviour do not benefit from classical CBT due to
serious troubles in generating feelings of contentment,
safeness or warmth in their relationship with themselves.
Compassion Focused Therapy addresses these problems
by training patients to develop and work with experiences
of inner warmth, safeness and soothing, via compassion
and self-compassion.
This presentation will outline the design and development
of a transdiagnostic CFT group over 10 sessions in 4
groups of 10 clients. Each group had 10 weekly 2 hour
sessions. Homework consisted of guided meditations,
recording of trigger situations, case conceptualization
and compassionate writing. Preliminary results are
very promising, showing marked improvement on all
measures such as BDI, BAI and Rosenberg´s self-esteem
questionnaire.
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EABCT 2012
Compassion focused imagery has been shown to have a
wide variety of physiological and psychological benefits.
This paper will report on the study exploring the benefits
independent home practice compassion-focused imagery
tasks for a non-clinical (N=45) population. Online audio
downloads were provided containing guided instructions
on three imagery tasks: i) practicing attention awareness
and focusing; body awareness in the form of soothing
rhythm breathing; ii) practising imagining oneself as
a compassionate person; and ii) practicing imagining
receiving compassion and care from another person or
being. Participants completed questionnaires measuring
self-criticism, self-reassurance, self-compassion, fears of
compassion and depression, anxiety and stress at pre and
post to practicing the imagery tasks and also completed
weekly diaries measuring their imagery experience.
After two weeks of regular practice there were significant
increases in self-compassion, self-reassurance,
experiencing positive emotions, social safeness and
attachment security, and significant reductions in selfcriticism, depression, anxiety and stress. In particular,
those scoring higher in self-criticism and other negative
variables at pre, showed the largest change in scores at
post.
EABCT 2012
S69-01
Maintaining mechanisms in Social Anxiety: The
predictive role of Anxiety Sensitivity is mediated
by Experiential Avoidance
Georgia Panayiotou1; Maria Karekla1; Margarita
Panayiotou1
1
University of Cyprus, Cyprus
Growing evidence supports that anxiety sensitivity is a
strong correlate of anxiety pathology. It may represent a
temperamental predisposition to anxiety, and evidence
suggests that it exerts its effects indirectly: Its association
with disorders like depression was found to be mediated
by experiential avoidance. Socially anxious individuals
are highly concerned about how apparent their somatic
symptoms may be to others, and therefore anxiety sensitivity
may play a role in this disorder as well. The present study
examines the role of experiential avoidance and anxiety
sensitivity in predicting social anxiety symptoms. The
model that experiential avoidance is a mediator between
anxiety sensitivity and anxiety symptoms is first examined
in a random community sample with all variables treated
as continuous (study 1). In study 2, highly socially anxious
individuals, who met relevant clinical cut-offs, were
compared to a matched control sample. The predictive
validity of the model in distinguishing between socially
anxious and control groups was tested. The hypothesis
was also examined that experiential avoidance and anxiety
sensitivity explain additional variance to that predicted
by Self-Consciousness and Sensitivity to Punishment/
Behavioral Inhibition, which are more widely documented
to predict social anxiety. Findings lend support to the
hypothesis that anxiety sensitivity is a predictor of
social anxiety mediated by experiential avoidance and it
was found that both of these constructs add significant
variance to the prediction of symptomatology on top
of that explained by other correlates. Implications for
potential intervention strategies tackling avoidant behavior
and anxiety sensitivity are discussed, so that social anxiety
can be remediated.
157
69
The effects of two weeks personal practising
three Compassionate Focused Therapy exercises
in a nonclinical population
Kirsten McEwan1; Paul Gilbert2
1
Kingsway Hospital Derby, United Kingdom; 2University
of Derby, United Kingdom
Symposium 69 - Anxiety Disorders in the
Real World: Correlates of Anxiety that
can Enlighten Treatment
Symposium
S68-04
Symposium
69
S69-02
S69-03
Perceived social support helps, but does not
buffer the negative impact of Anxiety Disorders
on quality of life and perceived stress
Maria Karekla1; Georgia Panayiotou1
1
University of Cyprus, Cyprus
Anxiety disorders are prevalent and substantially hinder
quality of life in all domains, including social connections,
mental and physical health and environmental adjustment.
Past research on stress indicates that perceived social
support improves wellbeing both directly by providing
positive experiences and indirectly through buffering the
effects of stress on health and psychological outcomes.
This study, conducted on a community sample in
Cyprus (N=324) screened for anxiety disorders using the
Psychiatric Diagnostic Screening Questionnaire, examined
whether social support moderates the negative impact
of anxiety disorders on quality of life. The hypothesized
model takes into account potential differences between
individuals with and without anxiety disorders in health,
tendency to seek support, stressful life events and
depression. Furthermore, differences between different
ADs on these variables were examined.
Results indicate that perceived social support has a
positive, direct effect on quality of life and perceived
stress for all participants, but that it does not moderate
the adverse effects of having an anxiety disorder on either
quality of life or perceived stress. The negative effects of
anxiety appeared to mostly be carried by the effects of
comorbid depression. Findings are discussed in terms of
potential interventions for anxiety disorders.
Preferred Dispositional Coping Styles in Anxiety
Disorders
Georgia Panayiotou1; Ioanna Mete1; Maria Karekla1
1
University of Cyprus, Cyprus
158
Anxiety and especially anxiety disorders tend to involve
avoidance motivation when it comes to facing feared
stimuli. Anxious individuals have also been found to
engage in experiential avoidance, which includes actions
and cognitions aimed at avoiding unpleasant internal
experiences (including anxiety itself). The present study
examined first the dominant ways of coping among
community participants in Cyprus who met screening
criteria for anxiety disorders and addressed the question
of whether some coping styles as compared to others are
more related to the experience of psychological distress
(here conceptualized as perceived stress measured with the
Perceived Stress Scale) for anxious participants. Second it
addressed possible differences in coping among individuals
selected for different Anxiety Disorder categories (i.e.
Generalized Anxiety Disorder, Panic Disorder, Social Anxiety
Disorder, Specific Phobia). Coping was measured with the
Brief COPE and the Action and Acceptance Questionnaire
(AAQ-II). Anxiety Disorders’ symptoms were assessed with
the Psychiatric Diagnostic Screening Questionnaire (PDSQ)
and the Fear Survey Schedule (FSS-III). The findings
indicated that avoidant coping and coping using expression
of negative feelings are particularly related to psychological
distress, whereas active/positive coping may help reduce
such distress but is not frequently encountered among
anxious groups. There were few differences in coping among
individuals with different types of anxiety symptomatology,
particularly in avoidance-oriented coping and negative
feelings which were characteristic of all anxious participant
groups. Among the Anxiety Disorders under study, GAD
seems to be associated with more maladaptive coping (e.g.
avoidance) and with a greater range of coping approaches
(perhaps indicating greater overall psychopathology and
distress), while Specific Phobias and Panic Disorder
seemed to be related to somewhat less maladaptive coping.
EABCT 2012
EABCT 2012
S70-01
Guided self-help via internet: From research to
clinical practice
Tine Nordgreen1
1
Haukeland University Hospital, Norway
Introduction: Self-help via the internet based on cognitive
behavioral therapy (CBT) is suggested as a way to meet the
needs for effective and accessible treatment for common
mental disorders.
Objectives and Methodology: In order to assess the
use of self-help via internet among psychologists in
Norway we conducted a survey through email.
Results: A total of 815 psychologists in clinical practice
(43%) responded to the survey. We found that self-help
materials were recommended as an adjunct and not
as an alternative to therapist contact by 73.0% of the
respondents, by 16.6% for relapse prevention, and by
1.2% to clients on a waiting list. Internet/computer-based
programs were recommended by 2.2% of the participants.
Discussion and Conclusion: Steps taken when
transporting research results from guided self-help trials
to ordinary clinical practice will be presented, with an
emphasis on recruiting and training therapists.
159
70
Predictors of Treatment Response in Brief,
Intensive Cognitive Behavioral Therapy for Acute
Anxiety
Sarah J. Kertz1; Andri Björnsson1; Katrina L. McCoy2; Joe
Bigda-Peyton1; Thröstur Björgvinsson1
1
McLean Hospital, Belmont, USA; 2West Virginia
University, USA
It has been clearly demonstrated that Cognitive Behavioral
Therapy (CBT) is effective in treating anxiety in controlled
research settings. Effectiveness research demonstrates that
CBT interventions are effective when delivered in clinical
practice. Despite the robust body of literature illustrating
the efficacy and effectiveness of CBT, questions remain as
to which patients are likely to improve during the course of
treatment and why. The purpose of the current project is to
identify predictors of anxiety symptom improvement in the
context of intensive group and individual CBT for mood
and anxiety symptoms. Therefore, we tested the hypothesis
that demographic factors, DSM-IV-TR diagnostic
characteristics, treatment expectancy/credibility, and
therapy skill acquisition would predict treatment outcome.
Treatment outcome was operationalized as reductions
in generalized anxiety, worry, and stress from pre- to
post-treatment. We constructed one regression for each
dependent variable. A total of 341 patients with at least
one anxiety disorder completed a battery of self-report
measures assessing generalized anxiety, worry, and
stress, at both pre- and post- treatment. Patients were
also administered a semi-structured diagnostic interview
pre-treatment. Results indicated that the regression model
predicting reduction in general anxiety was significant, F
(10, 174) = 16.40, p < .001, R2 = .46, and marital status,
treatment credibility, and CBT skill acquisition significantly
predicted reduced anxiety, p < .05. The regression
predicting improvement in worry was significant, F (10,
184) = 11.31, p <.001, R2= .35, and ethnicity, marital
status, a current major depression diagnosis, and CBT
skill acquisition all significantly predicted decreased
worry, p < .05. Finally, the regression model predicting
stress reduction was significant, F (10, 187) = 19.03, p <
.001, R2= .48, and ethnicity and treatment credibility both
significantly predicted decreased stress. The implications
and limitations of these findings are discussed, as well as
future directions.
Symposium 70 - How to spread the good
news – Dissemination of CBT in different
clinical contexts
Symposium
S69-04
S70-02
Symposium
70
Implementing CBT for OCD in a naturalistic
setting: The advantages of using group-treatment
in training of therapists
Ashild Hàland1
1
Sørlandet Hospital, Norway
Despite impressive empirical support for cognitive
behavioral treatment (CBT) for obsessive-compulsive
disorder (OCD), the availability of this treatment in
community mental health settings is still limited. One major
international problem is that few therapists have specialized
expertise in the treatment of OCD, which implies that many
patients do not have access to good quality treatment.
Given the potential benefit of CBT for OCD and its apparent
underutilization, there has been considerable discussion
as to how to improve the availability and attractiveness of
CBT for OCD. Perhaps the greatest challenge to overcome
barriers related to dissemination of CBT for OCD is training
clinicians to completely administer treatments. Based on
our experiences from an effectiveness study of behavioral
group treatment for OCD (Håland et al, 2010), the aim of
this presentation is to present a model for dissemination
of OCD treatment for adults and children/adolescents in a
regular mainstream out-patient clinic, with a particular focus
on group CBT in training of new therapists.
Reference: Håland, A.T, Vogel, P.A., Lie B., Launes, G., Pripp,
A.H., Himle, J.A. (2010). Behavioural group therapy for obsessivecompulsive disorder in Norway. An open community-based trial,
Behaviour Research and Therapy, 48, 547-554
S70-03
Preliminary data will be presented from this study which is a
multiple base – line study that follows traumatised children’s
changes in the level of mental – health problem – symptoms
and life – quality as they get PF as part of their brief, low –
intensive therapy.
S70-04
Implementation of the Psychological First Aid Kit
(PF) in Norway
Solfrid Raknes1
1
University of Bergen, Norway
The Psychological First Aid Kit is a self-help tool aiming
to promote health and prevent mental health problems
among children (aged 8 – 12) and youth (12 – 18). PF
intends to teach the user the basic principles of CBT within
an amusing context. PF consists of an information leaflet,
exercise sheets called «helping hands» and figurines.
The cartoonish drawings and the red and green plastic
figurines in the PF are designed to make the self-help
principles for young people easier and more attractive to
learn. An implementation-study of the PF for use in guided
self-help-settings in Norway will be presented. Helpers
(N=526) who work close to the children`s everydaylife (teachers, school-nurses, social workers and other
primary-health-carers) were given the PF kits. They were
allocated to two different education-settings: Half of them
received one day training, the other half received 2 days
training and 3 supervision-sessions. How satisfied and
confident are the helpers with using Psychological First
Aid kit (PF) in their work? Do they use the material, how
often and in what ways? The helper`s use of PF 3- and 6
months after their short-time course in learning how to use
PF will be presented.
Psychological First Aid Kit in Children house
Oslo
Shirley Stormyren1
1
The Childhouse Oslo, Norway
Children and adolescents potentially exposed to violence
or sexual abuse are forensically interviewed as part of a
police investigation. In Norway these interviews conducted
by special trained police officers take place in the Children
house where therapists follows the interviews from another
room - with the aim of giving the child mental health services
if needed after the interview has taken place. Children often
convey self-blame, thoughts about danger or other negative
thoughts during the forensic interviews. Psychological First
aid kit (PF) is experienced as a helpful tool as unhelpful
thoughts can be challenged during a few therapy sessions.
At the Children house Oslo we are aiming to screen twelve
children (age 11 -18) with trauma symptoms before and after
therapy, which will consist of 2-6 therapy sessions using PF.
160
EABCT 2012
Becoming a CBT Supervisor: Recommended
training Thomas Kalpakoglou1
1
Institute of Behaviour Research and Therapy, Athens,
Greece
The first efforts for establishing EABCT’s training
standards started in the 70’s. Various proposals and
drafts were created, forming a good foundation for CBT
Training in Europe. Together with all the input from all
member associations, EABCT continues to develop
and elaborate its training standards, making EABCT the
leading European Association on CBT training. Recently,
EABCT has developed a set of comprehensive guidelines
regarding the training and accreditation of CBT supervisors
(EABCT standards for the training and accreditation of
Cognitive Behavioural Therapists). In some countries
the practice of CBT supervision is restricted to specific
professional groups (CBT trained clinical psychologists
or psychiatrists). EABCT recognizes the regulations
governing each country but does not itself restrict entry
to CBT supervision to specific professional groups. It
is highly recommended that for their accreditation, CBT
supervisors need to have at least 5 years of experience
as CBT therapists, full membership in an EABCT member
association, accreditation as CBT therapists by an EABCT
member Association and relevant training and supervision
as CBT Supervisors. This presentation will give a detailed
account of all the requirements for the training and
accreditation of CBT supervisors, as set by EABCT.
EABCT 2012
Understanding supervision in context:
Implications for training supervisors Mark Freeston1
1
Newcastle University, United Kingdom
For many of us our early experiences of supervision were
in part focused on ourselves as the supervisee and so
followed a traditional psychotherapy model. Therapeutic
tasks and strategies with particular clients, developing as
a therapist, and identifying and addressing learning needs
were also important. Supervisor and supervisee often
came together through mutual consent and negotiated a
personal contract. Supervision when it worked well was
often a protected “bubble”, a safe, reflective space in
which to be challenged, to learn and to resource oneself
and so sustain what can be a difficult and demanding job
as a therapist. Although a requirement for professional
practice, supervision was often an essentially private
experience. People developed from supervisees to
supervisors through an informal maturation process often
developing their own supervisory practice by replicating
or reacting to the supervision they had experienced.
However, in the last decade, especially within the UK,
but also in other places, the demand for supervision has
massively increased. Supervision has also evolved from an
essentially private experience left to each supervisor and
supervisee to an increasingly organisationally mandated
and embedded relationship, where contextual factors are
explicitly present and/or impinge upon the supervisory
“bubble”. From a governance standpoint, the fact that
supervision is mandated and embedded (and increasingly
commissioned) gives supervision a much higher status,
but also leads to new tensions. The characteristics of
safety, reflection, client and therapy focus, development as
a therapist and support are highly desirable and valued
and most of us would agree that these features should be
retained. The challenge is how to balance and manage the
contextual demands and necessary links to organizational
contexts (service, training, professional, etc.) with the
need to create the bubble that we believe supports and
facilitates effective supervision.
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71
S71-01
S71-02
Symposium
Symposium 71 - How to teach CBT
Supervision Today?
Symposium
71
S71-03
S71-05
Steps towards a new concept of supervision in
French CBT associations
Nicolas Duchesne1; Frank Peyré2
1
Private practice, Montpellier, France ; 2Private practice,
Bordeaux, France
At the end of the XXth century, supervision was suspected
of being a « therapist ‘s therapy » because of the
imperialism of psychoanalytical thinking prevalent in the
world of psychotherapy in France. As a consequence, CBT
teaching was mainly limited to theoretical learning and
technical training. This way of managing young therapists
resulted in the poor dissemination of CBT in the health
services. Because of the media-supported awareness
of CBT’s efficacy and of the obviousness of the need for
guidance on the part of clinical practitioners, our CBT
association decided to create a task force to conceptualise
the specificities of supervision in our French context. We
will first share this nice collaborative experience : a team of
about thirty senior supervisors worked for 2 years (12 days
together, lots of homework and experience put together) in
order to develop our model and our practical tools. We will
subsequently briefly develop our way of supervising. We
now intend to organise a more formal course of training for
the more active teachers of the French association, so as to
increase the number of accreditated supervisors.
Training supervisors and teaching therapists in
CBT – Experiences from AVM-Austria
Anton-Rupert Laireiter1 and the commission on training
and teaching of AVM Austria
1
University of Salzburg, Austria
Training ongoing therapists needs well educated and
highly competent supervisors and teaching therapists –
the last ones offering personal therapy and self-reflection.
Although international discussion on criteria, methods
and processes in training ongoing therapists has a long
tradition, there is no similar one on teaching therapists
and supervisors.
In Austria, training supervisors and teaching therapists
is regulated at state level by a general prescription of
the ministry of health. On this basis AVM has developed
criteria for training supervisors and teaching therapists for
training in CBT subsequently.
In the speech the state as well as AVM criteria for training
supervisors and teaching therapists are presented as
well as experiences with them: People applying for
training in supervision and teaching therapy have to be
psychotherapists and must have been doing psychotherapy
continuously for at least for 5 years before starting
training. Training criteria of AVM allot basic (concepts and
methods of CBT, didactic of training and education etc.)
as well as advanced training (conceptions of supervision
and self-reflection; developing own conceptions, training
in supervision and personal therapy). In addition
every supervisor and training therapist gets advice
and supervision by his own for at least 15 hours from
experienced training therapists and supervisors. Rather
implicitly training therapists and supervisors have to have
academic training as a prerequisite too and have to obligate
themselves to undergo permanent skill enhancement.
Since the establishment of these criteria the standard of
training in AVM continuously accelerated. Feedback from
participants of our training supports this conclusion and
makes apparent that systematic training of supervisors
and teaching therapists is an important duty in training for
psychotherapy.
S71-04
The Swiss model: A guided exploration of the
scope of supervision
Xenia Heinze1; Roland Eiselé1
1
Private practice, Geneva, Switzerland
Five years ago, a group of senior CBT therapists was
invited by ASPCo, a leading CBT association in French
speaking Switzerland, to actively participate in the creation
of a model for CBT supervision. The different sub-domains
covered by supervision (e.g. supervision process,
supervisee’s context and expectations, skills acquisition,
the relationship between supervisor-supervisee) were
identified and organised in a map. This map will be
presented and vignettes of moments of supervision will
illustrate how it can benefit the supervision process. In
particular, it will be shown how this map model can help the
supervisor guide the process through the whole duration
of the supervisory relationship. Finally, some reflexions
based on a few years’ experience of this new supervision
concept will be shared, in order to highlight the challenges
that may be encountered in CBT supervision.
162
EABCT 2012
International Peace Negotiation and Social
Cognitive Psychotherapy: State of the Art,
Retrospect and Prospect
Francesco Aquilar1
1
AIPOOS, Naples, Italy
The contribution cognitive psychotherapy may be giving
to the field of international negotiation is not limited just
to identification of cognitive and metacognitive processes
useful for fruitful negotiations. It also regards the
management of psychological consequences of war and
terrorism as negative aspects of failed negotiation. The
contribution of cognitive psychotherapy as many authors
have been evolving till now, in the sphere of a psychology
for peace, can be summarized and grouped in some macrocategories, such as: prevention, managing, reparation. In
this presentation it will be described: 1) what cognitive
psychotherapy has done and can offer for international
peace negotiation and mediation; 2) what specific areas of
reference could help to improve the general understanding
of war and peace actions; 3) which kind of psychological
strategy can be utilized to improve peace negotiation.
Cognitive strategies for peace negotiations can be
divided in two broad categories, that will be explained: a)
Intervention on the citizens and the followers/supporters
of terrorism; b) Intervention on governments, politicians
and negotiators. Finally, an operative implementation
model is showed in detail.
References:
Aquilar F., Galluccio M. (2008), Psychological processes in international
negotiations, Springer, New York. Aquilar F., Galluccio M. (2011), eds.,
Psychological and political strategies for peace negotiation, Springer,
New York.
S72-02
International Peace Negotiation and Compassion
Paul Gilbert1
1
University of Derby, United Kingdom
Compassion is often seen as a highly desirable quality of
individuals in various forms of social interaction. However
compassion like other motivations can be increased or
decreased in certain environments. Compassion can in
fact the quite easy to turn off. This paper will argue that
international negotiations in so far as they focus on each
individual group trying to get the best deal for themselves
often mitigates against just and compassionate solutions
EABCT 2012
S72-03
Cognitive therapy in national conflict resolution:
The Lebanese experience
Aimee Karam1
1
St. George Hospital University Medical Center, Beirut,
Lebanon
A particular effort is constantly made to validate the foundation
of CBT and the scope of its efficacy in treating disorders
through an emphasis on the essential role of mediators
such as contents and cognitive styles that underlie the way
people build meanings and relate to their experience with
self, others, and the world. Recently, the idea of exploring the
implementation of cognitive therapy principles in enhancing
its use and efficacy in the area of conflict resolution and
political negotiation has been actively spread out. Authors like
Francesco Aquilar and Mauro Galluccio (2008) have been
particularly active in initiating teams’ reflection, workshops,
seminars and research in this area. The first part of this paper
aims at addressing the following points: I- What did we learn
so far from the CBT principles that we could apply in the area
of conflict resolution? II-How to benefit from CBT principles
to better prepare negotiators and better read the situation? IIINew researches and challenges.
S72-04
When negotiations fail: Conceiving a specific
and specialized training for international
negotiators
Olivera Zikic1
1
University of Nis, Serbia
What happened to ordinary Serbian population during
the last decades has been something ordinary people had
not even thought could have happened to us and to our
country. In 90s everything started by decomposition of old
Yugoslavia and secession of its republics. The consequence
of compromise failure during negotiation processes was the
start of the civil war among the peoples who had lived together
for many years in the past. What followed, were civil wars in
Croatia and Bosnia and Herzegovina, and finally the conflict
in Kosovo and three-months bombardment. The most
terrifying part of our lives in recent history starts after failure
of negotiation in Rambouillet, France. The consequences of
this failure were far reaching for the whole nation. Cognitive
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S72-01
and that one way around this is by third-party arbitration
and the rule of law. This talk will therefore outline the
basic evolved motivational and competency systems
underpinning compassion and how and where they can be
activated or deactivated.
Symposium
Symposium 72 - International peace
negotiation and cognitive therapy
and behavioral psychology and psychotherapy focused
techniques could help to find several tools to open the door
for a better understanding of psychological interdependent
dynamics within the realm of international negotiation and
for a far more cooperative way to try to resolve common
shared problems (Aquilar & Galluccio, 2008).
References:
Aquilar F., Galluccio M. (2008), Psychological processes in
international negotiations, Springer, New York.
S72-05
A Social Cognitive Approach to Preventive
Diplomacy and Conflict Transformation: The
Value of Inclusive Peace Negotiation Processes
Mauro Galluccio1
1
CRP, Italy; President of the European Association for
Negotiation and Mediation (EANAM), Brussels, Belgium
Symposium
73
The world of the international relations is dominated by a
structural uncertainty, where an effective authority and real
binding decision rules are missing. These are all conditions
that call for more cooperation and alliances among main
international actors to prevent and transform conflicts. It is
important a better understanding of the cognitive, emotional,
motivational, communication, negotiation processes and
of social mechanisms that incite the violence. This social
cognitive approach to the study of the conflict could help the
building of peace processes creating a common perception
of more legitimate grounds where the justice and human
rights could have more chances to be respected. The
implementation of successful inclusive peace negotiations
should also involve focused social cognitive training
for main politicians, negotiators and mediators, as well
as, tailored training programs for local leaders and their
communities. There are still too many situations where
local people are disconnected from peace agreements!
Conflict resolution and conflict transformation should be
approached through integrated psycho-political long-term
strategies aiming at sustainable negotiated agreements,
building up strong and positive relationships among main
actors in a way to contributing to their own communities
well-being. The social cohesion can be strengthened only if
citizens in their countries of origin are cognitively, socially,
and politically empowered achieving a real sense of whole
ownership of the peace processes and further agreements.
The United Nations Organization (UN) and the European
Union (EU) may lead this process as communication
mediums between and among member States (the UN and
the EU) and their citizens (more the EU) to disseminate and
mediate this new social cognitive approach to the nature of
governance, through cross-governmental actions, to reap
the rewards of this long-term strategy.
164
Symposium 73 - Mental imagery therapy:
Research and application in new fields
S73-01
Investigating an online imagery generation task
in depression
Arnaud Pictet1; Simon E Blackwell1; Emily A Holmes1
1
University of Oxford, United Kingdom
Introduction: Computerized procedures designed to
modify cognitive biases (CBM) underlying emotional
disorders are increasingly recognised as promising
candidates for treatment development. One specific version
of these CBM procedures targets negative interpretation
bias and the ability to generate positive mental imagery
of the future, two components of information processing
that have been shown to be problematic in depression.
Preliminary findings from two small-scale studies suggest
that imagery-based CBM can reduce depressive symptoms
in patients suffering from clinical depression. Although
encouraging, these results were limited by a short time
period of investigation and the use of specialised software
that are not easily accessible.
Objectives and Methodology: This pilot study aims
to test the feasibility of using an imagery-based CBM
program delivered over the internet to a sample of 8
individuals experiencing a current episode of Major
Depressive Disorder. Participants completed 12 sessions
of the CBM program from home over a one-month period.
Depression and anxiety symptoms, along with measures
of cognitive bias and mental imagery were assessed before
and after completion of the program, as well as at 1 month
follow-up.
Results: Results will be presented and will be focussed
on the primary outcome measure (Beck Depression
Inventory), as well as measures of cognitive bias and
mental imagery.
Discussion and conclusion: Results will be discussed
and the potential application of online imagery-based CBM
as a future intervention for depression will be discussed in
light of the preliminary findings.
S73-02
Imagery rescripting for psychological disorder
following cancer
Chris Brewin1; Katrina Whitaker1
1
University College London, United Kingdom
Introduction: Intrusive memories have been identified
in cancer patients and associated with psychological
distress and maladaptive adjustment. Imagery rescripting
EABCT 2012
S73-03
The neurofunctional bases of prospective mental
imagery in Bipolar Disorder
Martina Di Simplicio1; Emily A Holmes1; Guy M Goodwin1
1
University of Oxford, United Kingdom
Introduction: Increased rates of intrusive prospective
mental imagery have been associated with mood instability
and anxiety levels supporting a psychopathological model
of imagery as a “mood-amplifier” in BD. Patients also report
the struggle to contain this imagery process, switching
compulsively between different future simulations, unable
to select one likely prediction. To date this problematic
symptomatology remains disregarded in clinic and
nothing is known about its neurobiological basis.
Objectives and Methodology: This study aims to
identify the neural dysfunctions underpinning abnormal
prospective mental imagery in BD. Patients with a Bipolar
Disorder type 1, 2 or NOS are compared to age-matched
healthy controls in a between-groups experiment.
EABCT 2012
Participants undergo an fMRI session during which they
perform a prospective mental imagery task cued by selfrelevant positive/negative scenarios, followed by a resting
state period.
Results: Neuroimaging preliminary results will be
presented.
Discussion and Conclusion: The hypothesis will be
addressed that BD patients present overactive brain areas
during future mental imagery and alterations in neural
connectivity during rest after mental imagery compared to
controls. Implications for BD psychological treatment will
be also discussed.
Positive mental imagery task: Comparing
healthy controls and fibromyalgia patients with
or without signs of emotional distress
Chantal Berna1; Marco L. Loggia1; Christine Cahalan1;
Jieun Kim1; Emily A. Holmes2; Ajay Wasan1; Vitaly
Napadow1; Robert R. Edwards1
1
Harvard Medical School, USA; 2University of Oxford,
United Kingdom
Introduction: Positive mental imagery is a frequent
therapeutic strategy for patients suffering from chronic
pain. However, little is known about these patients’
ability to engage in positive imagery, and about potential
interference from intrusive distressing imagery.
Objectives and Methodology: We assessed imagery use
in a population of 42 patients suffering from fibromyalgia
with different levels of emotional distress (“high distress”
and “low distress”, as measured on a pain catastrophizing
scale), compared to 15 healthy volunteers. All underwent
experimental pressure-pain stimuli during which they
either focused on a personal positive mental image, or on
the painful sensation. A standard measure of trait mental
imagery (VVIQ) was collected at baseline. Subjective pain
intensity scores in each condition, positive task-imagery
vividness, attentional focus and catastrophizing during the
experimental pain were collected after the stimuli. A subset
of 8 high distress patients underwent a semi-structured
interview about the presence of spontaneous intrusive
imagery.
Results: Despite no significant difference on the VVIQ
(p>0.5), patients reported less vividness (p= 0.02), and
less ability to focus on the positive imagery (p= 0.03) than
controls. High and low distress patients scored similarly
on these measures (p>0.5). Participants with higher
pain catastrophizing scores during the mental imagery
sequences were less able to use this strategy for pain
relief (r= -.35, p<0.01). Finally, all interviews revealed
spontaneously occurring negative intrusive imagery linked
to pain.
165
73
S73-04
Symposium
is a psychological therapy that has proved successful for
reducing the impact and distress associated with intrusive
memories in various populations (e.g. depression), but
has not been applied to cancer patients. Different versions
of imagery rescripting employ it either as an adjunct to
cognitive therapy or use it as a stand-alone technique.
Objectives and Methodology: We report a single-case
design using rescripting as a stand-alone therapy for a
cancer patient with intrusive memories. Symptoms were
assessed with the Hospital Anxiety and Depression Scale
(HADS). Treatment was based on a manual developed for
use with depressed patients and consisted of 7 6o-minute
sessions. Verbal challenging of beliefs, behavioural
experimentation, or other standard components of
cognitive-behavioural therapy, were excluded by the
protocol.
Results: The patient’s score on the anxiety subscale of the
HADS decreased from 16 (severely anxious) at baseline to
9 (mildly anxious) posttreatment, and to 5 (non-anxious) at
6-month follow-up. Scores on the depression subscale of
the HADS also decreased from 11 (moderately depressed)
at baseline, to 6 (non-depressed) post-treatment, with a
further reduction to 2 at 6-month follow-up. In addition he
decided to return to work.
Discussion and Conclusion: Throughout the therapy
sessions, the negative imagery that was addressed
directly accessed feelings about the patient himself (e.g.
worthless), others (e.g. threatening), and the world (e.g.
dangerous/adverse). The outcomes obtained suggest
imagery rescripting may be of value in treating patients
with a variety of serious medical disorders experiencing
intrusive memories.
Discussion and Conclusion: These results suggest
that patients with fibromyalgia may have trouble creating
a vivid mental image when using positive imagery for pain
relief and techniques addressing this could be developed.
Further research is needed to assess potential lack of
spontaneous positive imagery and presence of significant
negative imagery in this population.
S73-05
Symposium
74
Revenge Phantasies in Imagery Rescripting
Exercises – Helpful or Dangerous?
Gitta Jacob1; Laura Seebauer1
1
University of Freiburg, Germany
Introduction: Imagery rescripting of traumatic childhood
memories and other stressful life events is increasingly
used in the treatment of patients with severe emotional
problems including e.g. patients with cluster B personality
disorder with intense aggression and anger. These patients
often suggest to act out revenge fantasies in the imagery
exercise. However possible consequences are subject
of controversy. Research shows that fantasized actions
may increase the future probability of actually acting in
the fantasized way. On the other hand, revenge fantasies
often seem to be very useful in terms of calming down
the patient and helping him/her to express emotions and
needs more clearly and in a more healthy way.
Objective: We conducted both a clinical case series and an
experimental study to investigate emotional consequences
of revenge images in imagery rescripting exercises.
Methodology: In the clinical case series, individual
imagery rescripting exercises including revenge fantasies
are applied and its effects are carefully observed. In the
experimental study, 50 healthy participants watched a
series of traumatic movie segments; after each movie
segment, one of three imagery strategies are applied to
regulate emotions: (1) imagery rescripting with revenge
fantasies, (2) imagery rescripting without aggressive
content, (3) safe place imagery. Emotions are rated before
and after each movie segment and after each emotion
regulation strategy. Data are currently analyzed.
Results: So far, clinical cases responded very well to
imagery rescripting with revenge fantasies. No problems
with aggression occurred after using this technique. In
the trauma film experiment, imagery rescripting with and
without revenge phantasies renders very similar results.
Conclusion: Revenge fantasies seem to be applicable; we
did not find aversive effects so far, clinical experiences are
very positive. However, this technique has not been tested
yet in highly aggressive patients and results cannot be
generalized to this population so far.
166
Symposium 74 - Emotion regulation
in affective disorders and their
neurobiological correlates
S74-01
Brain catecholamines and reward processing in
major depression
Gregor Hasler1
1
University Hospital Bern, Switzerland
Impaired function in the processing of reward-related
stimuli may constitute a key behavioral endophenotype
in major depressive disorder (Hasler et al.,
Neuropsychopharmacology 2004). This behavioral deficit
possibly reflects the biological endophenotype of reduced
mesolimbic dopaminergic function in depression.
An instructive paradigm for investigating the relationship
between catecholaminergic function (i.e., central
dopaminergic and noradrenergic neurotransmission) and
the risk of depression has involved the mood response to
catecholamine depletion, achieved by oral administration
of alpha-methyl-paratyrosine, a competitive inhibitor of
tyrosine hydroxylase.
A tool that facilitates investigations of the relationship
between central catecholaminergic function and
impairments in reward processing in depression is the
Monetary Incentive Delay (MID) task of Knutson et al.
This task assesses appetitive and effort-related aspects of
central reward processing in humans.
Under catecholamine depletion subjects with a risk for
depression (personal or family history of depression) were
robustly differentiated from controls by development of
performance deficits on the MID task. These performance
deficits correlated directly with the return of depressive
symptoms following catecholamine depletion.
In a limbic-cortical-striatal-pallidal-thalamic network
metabolism increased in subjects at risk of depression but
decreased or remained unchanged in controls following
catecholamine depletion determined by positron emission
tomography. Depletion-induced anhedonic symptoms,
as a reflection of impairments in reward processing,
correlated with changes in brain metabolism in the
anteroventral striatum (nucleus accumbens).
The sensitivity of central reward processing systems to
reductions in brain catecholamine levels thus appears
to represent a trait-like marker in major depression
disorder. The significance of these findings with respect
to psychotherapy and pharmacotherapy and their
combinations will be discussed.
EABCT 2012
Emotion regulation in the context of affective
disorders – deficits and treatment possibilities
Larissa Wolkenstein1
1
University of Tuebingen, Germany
Emotion regulation may be defined as the ability to
manipulate emotion antecedents or one or more of the
components of the emotional response. The ability
to modify the emotional experience is an essential
precondition for the maintenance of psychological wellbeing and social functioning. Affective disorders are
prima facie associated with deficient emotion regulation
skills. We examined emotion regulation skills of patients
with unipolar and bipolar affective disorders as well
as their ability to exert cognitive control over emotional
distractors which can be understood as an ability that
underlies response-focused emotion regulation strategies.
Furthermore, we will discuss different possibilities to treat
emotion regulation deficits.
Emotion regulation deficits as disease and
vulnerability marker for bipolar disorder:
Findings from neurobiological studies
Michèle Wessa1; Sandra Schönfelder1; Johanna Forneck1;
Philipp Kanske1
1
University of Heidelberg, Germany
Bipolar disorder is characterized by increased emotional
reactivity. Further, impaired regulation of these
heightened emotional responses has been supposed
to be one important characteristic of the disease. This
assumption is based on clinical observations but also on
neurobiological models of bipolar disorder, proposing an
inefficient inhibitory feedback loop comprising prefrontal
and limbic brain regions increased limbic brain activity.
So far, emotion regulation capacities and their neural
underpinnings have only been scarcely investigated
in patients with bipolar disorder. Further, it is not clear,
if the hypothesized impairments in emotion regulation
in bipolar disorder represent a disease or vulnerability
marker. In four studies we investigated emotion regulation
through reappraisal and distraction in (1) patients with
bipolar-I disorder (N=22), (2) patient with unipolar
depression (N=26), (3) unaffected first-degree relatives
(N=17) of patients with bipolar disorder and (4) healthy
individuals with hypomanic personality and thus at risk
to develop bipolar disorder (N=22) and respective control
groups (Total-N=87) with a functional magnetic resonance
imaging (fMRI) paradigm. On a behavioral level, we did
not see any differences in emotion regulation in any of
the clinical or high-risk groups compared to the control
groups. However, on the neural level we observed inefficient
emotion regulation, indicated by lower reductions in
amygdala activity during reappraisal, in all clinical and
high-risk groups as compared to healthy controls without
heightened risk to develop bipolar disorder. Interestingly,
in bipolar patients and their first-degree relatives this effect
was observed for positive and negative stimuli, whereas
in patients for unipolar depression, inefficient emotion
regulation was shown for negative stimuli only.
Our results provide first evidence that inefficient emotion
regulation – at least on a neural level – represents a
disease but also vulnerability marker for bipolar disorder.
Very first results also show that this emotion regulation
deficit might be reversible by cognitive-behavioral therapy.
S74-03
Neural correlates of mindfulness and cognitive
control in major depressive disorder
Annette Beatrix Brühl1; Uwe Herwig1
1
University Hospital of Psychiatry Zurich, Switzerland
Depressive episodes are characterized by disturbed
emotion regulation. Typical psychotherapeutic techniques
used in the treatment of depression are cognitive and
mindfulness-based strategies. In healthy subjects, topdown regulatory effects of cognitive control by reappraisal
are represented by increased prefrontal activity and
decreased activation in the amygdalar region. Mindful
introspection had a similar effect in healthy subjects,
resulting in a reduced activity of the amygdala even
below baseline and an increased activity in the medial
prefrontal cortex. In patients suffering from a depressive
episode, activity in occipital and thalamic regions as well
as the cingulate cortex was reduced compared to healthy
subjects when applying cognitive control. During mindful
introspection, depressed patients were able to reduce
amygdalar activity, however, they had increased prefrontal
activations compared to healthy subjects. This can be a
correlate of a stronger recruitment of cognitive resources
in depression during mindful focusing.
These studies can help elucidate deficits in emotion
regulating circuits in major depression and identify
biological markers indicative of response to different
emotion regulation strategies.
EABCT 2012
167
74
S74-04
Symposium
S74-02
Symposium 75 - Macht Arbeit Krank?
S75-01
Symposium
75
Erfolgreiche Integration am Arbeitsplatz nach
längerer Abwesenheit
Rolf Victor Heim1
1
Private practice, Holderbank, Switzerland
Chronische oder schwere Krankheiten, schwerere
Unfällen oder lang dauernde Überlastungen führen
oft zu monatelangen Absenzen. Eine derart lange
Krankschreibung kann die Integration der Betroffenen in
den primären Arbeitsmarkt gefährden. Nach 6 Monaten
Abwesenheit beträgt die Integrationswahrscheinlichkeit im
Schnitt 50%, nach 12 Monaten nur noch 5%! Während
der Abwesenheit organisieren sich sowohl die Betroffenen
wie auch das Team und arrangieren sich mit der Situation.
Betroffene zweifeln, ob sie ihre Arbeit in Zukunft noch
leisten können und ob sie weiterhin gebraucht werden. Auf
der Seite des Arbeitgebers schwinden häufig Verständnis
und Goodwill und weichen einer wachsenden Ungewissheit
in die Leistungsfähigkeit des Betroffenen. Unter diesen
Umständen ist der Integrationsprozess praktisch schon zu
Beginn zum Scheitern verurteilt…
Daher braucht es das sorgfältige Zusammenspiel
von mehreren Stellen: Betroffene, Vorgesetzte,
Personalfachstelle, Vertreter aus dem ärztlichtherapeutischen Bereich und Case-ManagerInnen.
S75-03
Therapie bei Burnout
Andi Zemp1
1
Privatklinik Wyss, Münchenbuchsee, Switzerland
Burnout kann gesehen werden als eine „normale“
Reaktion auf eine „abnormale“ Situation – nämlich eine
Folge chronischer Stressüberlastung bei der Arbeit,
die zu einem dauerhaften, negativen Gemütszustand
führt. Ursache ist eine ungenügende Bewältigung
arbeitsrelevanter
Belastungen
beziehungsweise
eine mangelnde Übereinstimmung zwischen den
Ressourcen und Eigenschaften eines Arbeitnehmers
und seiner Arbeitsumgebung. Als Risikofaktoren bei der
Entstehung eines Burnouts gelten einerseits bestimmte
Charakteristika oder Einstellungen des Individuums,
andrerseits spezifische Arbeitsbedingungen. Die
Interaktion persönlicher Eigenschaften mit denjenigen des
Arbeitsplatzes führen bei den Betroffenen zur subjektiven
Wahrnehmung von Stress und bei Dauerbelastung zu
einer Burnoutsymptomatik. Dabei stellt die Erschöpfung
die wesentliche Komponente dar. Weiter dazu gehören
Zynismus, Demotivierung sowie eine deutlich reduzierte
individuelle Leistungsfähigkeit.
Ziel: Vermittlung eines interdisziplinären Konzeptes zur
Behandlung von Burnout.
S75-02
Der lange Arm der Arbeit: Risiken für Gesundheit
und Sicherheit in Verkehr, Sport und Freizeit
Achim Elfering1
1
University of Bern, Switzerland
Erwerbsarbeit wird kognitiv intensiver. Arbeitsmengen,
enge Zeitlimiten, und Konzentrationsanforderungen
nehmen zu, während Pausen gekürzt werden. Die
kognitive Erschöpfung nach der Arbeit ist daher oft gross.
Gleichzeitig fördert die intensivere Arbeit auch ausserhalb
der Arbeitszeit eine gedankliche Weiterbeschäftigung
mit Arbeitsinhalten, die wiederum die Erholung von
der Arbeit gefährdet. In diesem Beitrag werden neue
Forschungsbefunde zu Arbeitsanforderungen sowie
Erholung, kognitiven Fehlern, und Sicherheit ausserhalb
der Arbeitzeit vorgestellt. Neben Schlafbeeinträchtigungen
stehen dabei Beinaheunfälle und Unfälle nach der Arbeit
im Fokus. Gute Arbeitsgestaltung und betriebliche
Gesundheitsförderung können dazu beitragen, das
Unfallrisiko während des Arbeitsweges, bei häuslichen
Tätigkeiten und im Sport zu reduzieren.
168
EABCT 2012
EABCT 2012
S76-01
Le cerveau en pleine conscience et la régulation
des émotions dans les troubles de l’humeur
Guido Bondolfi1; Françoise Jermann1; Ariane Zermatten1
1
Hôpitaux Universitaires de Genève, Switzerland
La méditation pleine conscience implique l’allocation
des ressources attentionnelles sans porter de jugement à
l’expérience du moment présent. Utilisé dans la pratique
clinique, l’utilisation de la méditation pleine conscience
promeut la diminution du stress, des ruminations et des
affects négatifs ainsi que l’augmentation du bien-être. Au
niveau neuronal, les mécanismes de régulation de l’humeur
par la pleine conscience sont à peine compris. L’entraînement
à la pleine conscience semble améliorer les systèmes de
surveillance attentionnelle dans le cerveau humain. Chez
les patients souffrant de troubles affectifs, la formation en
méditation pleine conscience peut être un substitut aux
efforts cognitifs pour réguler les émotions, efforts soustendus par une activité dysfonctionnelle dans le cortex
préfrontal, dirigeant les ressources attentionnelles vers
les voies cérébrales impliquées dans la pleine conscience
sensorielles du moment présent. Les voies par lesquelles la
méditation pleine conscience exerce ses effets en tant que
tel sont supposées être liées à la régulation de l’attention,
à la conscience du corps, à la régulation des émotions et
au changement de perspective sur soi. Nous présentons
quelques résultats de l’étude du Geneva Meditation Group.
S76-02
Au coeur des fluctuations thymiques, la pleine
conscience: Protocole de traitement adapté
aux caractéristiques de personnes souffrant de
troubles bipolaires
Béatrice Weber1; Jean-Michel Aubry1
1
Hôpitaux Universitaires de Genève, Switzerland
Introduction: La thérapie cognitive basée sur la pleine
conscience a montré son efficacité dans la prévention
des rechutes dépressives chez les sujets unipolaires en
rémission. Des travaux ultérieurs ont apporté des résultats
encourageants en présence de symptômes dépressifs et
anxieux, voire de troubles bipolaires. Selon un modèle
intégratif cognitif (Mansell 2007), le maintien et l’exacerbation
de symptômes bipolaires sont le fait de croyances multiples,
extrêmes, conflictuelles concernant les changements d’états
internes perçus, croyances se répercutant à leur tour sur les
comportements, la physiologie et l’environnement social
169
76
Soziale Stressoren, Schlaf und Erholung am
Wochenende
Diana Pereira1, Rolf Heim2
1
University of Bern, Switzerland; 2Private Practice,
Holderbank, Switzerland
Die Arbeit nimmt im Leben eines Menschen eine wichtige
Rolle ein. Trotz den positiven Auswirkungen, welche die
Arbeit zu haben scheint (z.B. Selbstverwirklichung, Geld
einbringende Quelle, u.v.m.), warnen einige Forscher vor
den negativen gesundheitlichen und psychologischen
Folgen von Stress am Arbeitsplatz. Das bindende Glied
scheint die Erholung von der Arbeit zu sein. Zahlreiche
Studien konnten bereits darauf hinweisen, dass eine
ungenügende Erholung von der Arbeit z.B. durch
schlechte Schlafqualität, für die Prozesse verantwortlich
zu sein scheint, welche aus kurzfristigen Stresszuständen
langfristige werden lässt. Obwohl das Wochenende die
Möglichkeit darstellt sich von den Arbeitsstressoren
erholen zu können, konnten einige Studien zeigen,
dass der „lange Arm“ der Arbeit die Erholung nicht nur
am Feierabend, sondern sogar an Wochenenden zu
beeinträchtigen vermag. Bisher ist die Forschung in
diesem Gebiet eher spärlich. Unsere Studie stellt den
Versuch dar die Forschung in diesem Gebiet zu erweitern.
In einer Tagebuchstudie untersuchten wir die Effekte von
sozialen Stressoren am Arbeitsplatz auf den Schlaf und
die Erholung während des Wochenendes. 42 Arbeiter
mehrerer Firmen nahmen an der Studie teil. Von Samstag
bis und mit Montag mussten die Teilnehmer ein Aktigraph
am Oberarm tragen, welcher u.a. Anzahl Schritte,
Kalorienverbrauch und Schlaf mass. Unsere Ergebnisse
zeigen, dass sozial gestresste Menschen am Sonntag
und am Montag eine ungenügende Erholung berichten.
Ausserdem schlafen sozial gestresste Arbeitnehmer in der
Nacht von Sonntag auf Montag qualitativ schlechter.
Unsere Ergebnisse stützt die bisherige Forschung und
zeigen, dass Stress am Arbeitsplatz die Erholung nicht
nur am Abend, sondern sogar am Wochenende zu
beeinträchtigen vermag. Mangelnde und ungenügende
Erholung gilt als Risikofaktor für zahlreiche Erkrankungen,
z.B. Herzinfarkt. Deshalb sollten sich Organisationen
bemühen sowohl Stressoren als auch Faktoren, welche
die Erholung zu beeinträchtigen vermögen zu vermeiden.
Symposium 76 - Regards croisés sur la
pleine conscience
Symposium
S75-04
Symposium
76
de l’individu. La théorie du contrôle perceptuel (Perceptual
Control Theory) apporte des éléments de compréhension
(Mansell 2011 ; Higginson et al 2011) sur les troubles et le
changement thérapeutique.
Objectifs: Sur la base d’études antérieures, du modèle
conceptuel de Mansell et de notre expérience clinique
de conduite de groupes MBCT et MBSR auprès d’une
population bipolaire, nous examinerons comment
ajuster l’approche basée sur la pleine conscience aux
caractéristiques de la maladie bipolaire. Hormis des
adaptations de longueur et type de pratiques proposées,
seront introduits des thèmes liés à l’hypersensibilité au
stress, ainsi qu’aux évaluations positives et négatives
extrêmes, multiples, personnalisées des états internes
engageant le sujet dans des attitudes et conduites
exacerbant les fluctuations thymiques. Des témoignages
de patients sur les bénéfices tirés de la pratique de pleine
conscience viendront étayer nos propositions.
Conclusions: Offrir au sein de notre programme spécialisé
bipolaire une approche de mindfulness, s’inscrivant dans une
médecine participative et spécifiquement ajustée aux sujets
souffrant de cet affection, vulnérables au stress et manifestant
pour certains des fluctuations d’humeur très rapides, semble
pertinent, en complément aux traitements standards
S76-03
La prévention de la rechute basée sur la pleine
conscience pour le traitement des troubles
addictifs
Daniela Dunker Scheuner1
1
Centre Hospitalier Universitaire Vaudois (CHUV),
Lausanne, Switzerland
Différents modèles thérapeutiques ont adapté la pratique
de la pleine conscience à la thérapie et leur efficacité a
été scientifiquement validée dans plusieurs domaines.
Au delà des approches incluant la pleine conscience, 3
approches se sont basés sur la pleine conscience, dont
le MBSR (Mindfulness based stress réduction), le MBCT
(Minduflness based cognitive therapy), et plus récemment
le MBRP, (Mindfulness based relapse prevention) pour
des personnes présentant un abus de substance. Ils sont
tous les trois très semblables, proposant un programme
thérapeutique en 8 séances hebdomadaires, sauf certains
exercices et spécificités.
Le but de ma présentation est d’arborer les spécificités de
la troisième application clinique de la pleine conscience,
soit le programme adapté par Alan Marlatt, le MBRP.
Marlatt a souvent utilisé l’expression « surfer sur les
envies » dans son modèle de prévention de la rechute
développé dans les années 80 ; mais n’a développé un
programme structuré à ce propos que très récemment, le
manuel ayant été publié en 2011. L’idée est d’apprendre
170
aux participants qui présentent un abus ou dépendance
à une substance à accepter les envies et émotions qui
apparaissent sans réagir automatiquement, ce qui permet
de les gérer autrement.
Concernant les différences entre le programme MBRP et
MBCT, certaines séances (1, 3, 5 et 8) sont pratiquement
identiques, sauf quelques détails qui sont recherchés dans
les discussions après les exercices, comme par exemple
le lien entre le pilote automatique et la rechute.
D’autres séances (2, 4, 6 et 7) proposent des exercices
spécifiques pour le travail autour de la prévention de la
rechute et l’expérience de surfer sur l’envie. Ces exercices
seront brièvement présentés, ainsi qu’une particularité
de ce programme qui est l’introduction d’un exercice de
méditation qui n’apparaît pas dans les autres programmes,
la méditation de la compassion ou méta. En effet, malgré
le fait que les modèles MBSR et MBCT incluent d’autres
nombreuses techniques fondamentales pour la méditation
vipassana, des pratiques explicites de méta ne sont pas
comprises dans ces deux programmes.
S76-04
Entraînement à la pleine conscience pour
atténuer les symptômes psychotiques persistants
Sabrina Bardy1; Diana Ortega1; Shyhrete Rexhaj1; Charles
Bonsack1; Jérôme Favrod1
1
Centre Hospitalier Universitaire Vaudois (CHUV),
Lausanne, Switzerland
Vingt à cinquante pourcent des personnes atteintes de
schizophrénie souffrent de symptômes psychotiques
persistants malgré un traitement neuroleptique.
L’entraînement à la pleine conscience offre une piste pour
les aider en proposant de nouvelles perspectives pour
modifier le rapport aux symptômes positifs. Une étude
pilote avec cette technique a été mise en place dans notre
service. Quatre patients atteints de schizophrénie et une
patiente souffrant d’un trouble schizo-affectif ont participé à
huit séances inspirées des techniques de pleine conscience
et d’acceptation en setting groupal. Avant, pendant et après
l’entraînement, ces personnes ont évalué hebdomadairement
la gêne causée par un symptôme psychotique cible. La
courbe des évaluations et les retours des participants
décrivent une diminution de cette gêne. En fonction de
cette première expérience et de nouvelles demandes de
participation formulées, le module a évolué et s’est ouvert
à d’autres problématiques rencontrées dans notre service.
Ce mouvement c’est effectué naturellement, dans le contexte
d’une unité soucieuse d’éviter toute forme de discrimination
et orientée dans la direction du rétablissement comme
processus en perpétuel changement. Quelques exemples
concrets permettront d’illustrer la méthode, la structure des
séances, ainsi que de présenter le matériel utilisé lors des
EABCT 2012
S76-05
Approche cognitive basée sur la pleine
conscience pour les seniors (MBCAS):
programme d’entraînement de huit mois
Brigitte Zellner Keller1
1
Université de Lausanne, Switzerland
Le MBCAS est une de ces approches basées sur la pleine
conscience dans une perspective de développement
personnel. Ce programme de huit mois est destiné à des
personnes retraitées, en assez bonne santé, vivant à domicile.
L’objectif est de développer des compétences de pleine
conscience comme ressource psychologique supplémentaire
face aux défis du vieillissement, tant sur les plans physiques,
cognitifs et psychosociaux.
Le dispositif de huit mois est conçu pour favoriser l’intégration
et l’appropriation de nouveaux outils. Il permet d’accompagner
les participants dans ce lent processus d’apprentissage
depuis l’observation des sensations corporelles jusqu’à celles
des émotions et des pensées, en prenant en considération
les fluctuations inhérentes de la pratique personnelle au
quotidien. Les exercices cognitifs, les mouvements en pleine
conscience sont adaptés aux seniors.
Les participants âgés disposent d’un éventail varié
d’expériences et stratégies, qui peuvent refaire surface lors
des discussions. Outre le développement de l’acceptation du
passé, l’instructeur peut valider ce matériel comme proposé
par Cappeliez (2008, 2009). Selon ses objectifs en séance,
l’instructeur peut ainsi se concentrer sur l’aspect intégratif des
réminiscences - par exemple pour raviver l’estime de soi, ou
sur l’aspect instrumental des réminiscences - par exemple
pour faire ré-émerger une méthode de résolution de problème
comme type de réponse s’étant avéré efficace en certaines
circonstances. Il est supposé que cette réinterprétation du
passé facilite chez le senior le processus de dés-identification
de ses expériences internes, car les souvenirs d’échecs
pouvant être laissés, le présent devient moins contaminé.
A l’issue de cette présentation, quelques résultats et
commentaires extraits des fiches d’auto-observations et
des évaluations finales des 40 premiers participants seront
évoqués, avec en perspective l’impact de cet entraînement
sur la qualité de vie des personnes.
EABCT 2012
S77-01
Forgotten and retrieved?
Sandra Sassaroli1
1
Studi Cognitivi Psychotherapy School and Research
Institute, Italy
Perceived control is conceived as a transdiagnostic factor
relevant across a broad range of emotional disorders.
Early work by Bandura on self efficacy and later work by
Barlow and colleagues have pointed to this construct as
central to the experience of distress. Rapee applied this
model to anxiety. Sassaroli and Ruggiero propose a
conceptualization of control as a life goal around which
patients would organize their life plans. This imply
that these patients envisage their life in prudential and
avoidant terms. Therefore, therapists should encourage
their patients to conceive the committment to give up
controlling attitudes in terms of acceptance of a degree of
explorative risk in their life.
S77-02
Anxiety control as a consequence of a lack of
perceived control
Ronald M Rapee1
1
Macquarie University, Sydney, Australia
Models of the maintenance of anxiety disorders often
emphasise either a perception of heightened threat as
underlying the disorder or a sense of low control. It is
likely that in fact both of these factors are important to
the maintenance of anxiety disorders. Most anxiety is
characterised by a perception that threat is present and
imminent combined with a perception that the individual
is unable to control or protect themself from that threat.
Different forms of anxiety will be characterised by either
bias to a greater or lesser degree. For example, physically
focussed disorders (such as panic disorder) are maintained
primarily by biases in perceptions of threat, while socially
focussed disorder (such as social phobia) are more
strongly maintained by biases in perceptions of control.
Low perceptions of control also play a key maintaining
role in other neurotic disorders such as depression.
Given its relevance to the maintenance of several
disorders, perceived control can be thought of as a core
transdiagnostic factor. It is therefore an ideal candidate for
treatment since increasing perceptions of control should
have a broad influence on a number of conditions.
171
77
References:
Bardy, S., Ortega, D., Rexhaj, S., Maire, A., Bonsack, C., & Favrod,
J. Entraînement à la pleine conscience en groupe pour atténuer les
symptômes psychotiques persistants. Accepté par Annales Medicopsychologiques, en attente de publication
Symposium 77 - Round Table - THE ROLE OF
CONTROL IN PSYCHOPATHOLOGY
Symposium
séances. L’observation des résultats de cette expérience
pilote a encouragé le maintien de cette offre et ouvert des
perspectives d’extension du module, en fonction d’ objectifs
de vie plus personnels et spécifiques, pour des patients déjà
familiarisés avec ces techniques d’ancrage et d’accueil des
sensations, pensées, et émotions au présent.
S77-03
Application to pathological control of LIBET (Life
themes and plans Implications of biased Beliefs:
Elicitation and Treatment)
Giovanni M Ruggiero1; Sandra Sassaroli1
1
Studi Cognitivi Psychotherapy School and Research
Institute, Italy
Symposium
77
Standard cognitive-behavioural models of emotional
disorders and treatment stressed the importance of biased
aspects of cognition and their reframing. Third wave models
shifted the focus on metacognition, cognitive processes,
acceptance and validation of sufferance, emotional guided
imagery and analysis of values and not only of beliefs. This
workshop aims to develop some of the above mentioned
third wave concepts. First of all, we reformulate Hayes’
concept of “values” in terms of elicitation of the life plan
implied by biased beliefs. A life plan permits to focus more
clearly on the “cash value” and goals-oriented aspects of
Hayes’ values. This means that the therapist encourages the
patient to describe the disorder as a life plan that privileges
avoidant, controlling and/or reactive attitudes. Such a
model has is roots in Ellis’ (1962) attention to cognition as
goals and in Lehay’s (1997) attempt to consider disorders
as rigid but semi-adaptive states adjusted on a particularly
high sensitivity to emotional frustration. In terms of
therapeutic interventions, this means that, in addition to
standard cognitive interventions, it could be possible to
formalize a training for coping with emotional pain and
frustration arranged as follows: 1) encouraging the patient
to (euristically) describe the disorder as a conscious and
voluntary life plan that privileges avoidant, controlling
and/or reactive attitudes in order to increase the sense of
mastery; 2) imagining a concrete and realistic scenario of
emotional well-being that involves the more painful and
frustrating and feared aspects of “functionality”; 3) learning
to criticize idealised healthy states that do not involve any
form of frustration or emotional pain; 4) guided imageries
aimed at experiencing the most painful and unacceptable
aspects of functional (or less biased) cognition, in which
the patient is encouraged to “stay for a moment in the most
unacceptable and frustrating aspects of what we agreed that
should be accepted” (this intervention is similar but more
painful to ACT acceptance: “do not accept now, experience
unacceptance!”); 5) using Kellian (Kelly, 1955; Bannister,
1960) dilemmatic representations as euristics that help
the patient to better understand his or her avoidance of
frustrating aspects of healthy states (Feixas, Saúl, 2004;
Lorenzini, Sassaroli, 1995); 6) debriefing from “training
for coping with emotional pain and frustration” using 6
“third wave” CBT tecniques: 6.1) validation (Linehan,
1993); 6.2) standard cognitive reframing; 6.3) exploring
developmental and relational roots of painful emotional
172
and cognitive states (Sassaroli, Lorenzini, Ruggiero,
2005; Lehay, 1997); 6.4) skills training (Linehan, 1993);
6.5) mindfulness (Teasdale, 1999); 6.6) metacognitive
processes reframing (Borkovec, 1994; Watkins, Moberly,
2009; Spada, Caselli, Wells, 2012). In the case of
control, LIBET recommends 1) encouraging the patient to
recognize control as a life plan aimed at increasing the
sense of mastery in a rigid way; 2) guided imageries about
the experience of losing control.
S77-04
The role of metacognitions in sustaining
pathological monitoring and controlling
strategies
Gabriele Caselli1,2
1
Studi Cognitivi Psychotherapy School and Research
Institute, Italy; 2London South Bank University, United
Kingdom
Theory and research in metacognition has been introduced
as a ground for understanding and treating psychological
dysfunction (Wells, 2000; Wells & Matthews, 1994; 1996).
The Self-Regulatory Executive Function (S-REF: Wells
& Matthews, 1994) model proposes that psychological
dysfunction is maintained by a style of managing thoughts
and emotion that involves extended thinking (e.g. worry
and rumination), threat monitoring, avoidance and thought
suppression.
This style is termed the Cognitive Attentional Syndrome
(CAS) and it could be considered as a dysfunctional mode
of information processing that causes negative thoughts
and emotions to persist, as it fails to modify dysfunctional
self-beliefs, increases the accessibility of negative
information and interferes with the down-regulation of
emotion (Wells, 2000, 2009).
One main difference with other conceptualizations of
control is not on the acceptance of lack of control but on the
improvement of a flexible control of cognitive strategies,
components of the CAS, and on the modification of belifs
about uncontrollability of these components.
The S-REF model has led to the development of disorderspecific formulations and treatments for depression
(Wells, 2009), generalized anxiety disorder and other
anxiety disorders.
EABCT 2012
Papers
Paper Session 1 - Couple and intimate
relationships
PA 01-01
Papers
1
Psychological and Demographic Characteristics
of Individuals who engage in online sexual
activity
Marcus Squirrel1; Ann Knowles1; Mike Kyrios1
1
Swinburne University of Technology, Australia
The dramatic growth of the Internet has resulted in an
estimated 2.28 billion users worldwide in December 2011,
and its use for sexual purposes is a growing phenomenon.
The impact of exposure to pornography on its consumers is
a highly debated and extensively studied topic. Advocates
of online sexual activity (OSA) have emphasized sexual
exploration, or highlighted educational benefits and
advantages for socially disenfranchised individuals such
as gay, lesbian and bisexual (GLB) individuals. The overall
aim of this paper is to report the findings of an online study
that investigated the relationship between participant’s
sexual orientation and their OSA, offline meeting behaviour
and psychological characteristics. The psychological
variables investigated included measurers of participants’
depression, anxiety, stress, impulsivity, social and
emotional loneliness, and their adult attachment style.
International data for the current study were collected via
an online questionnaire posted on the Internet. Data was
collected from 1325 participants aged 18 to 80 years, with
males composing 91% of the sample. Thirty nine per cent
of the sample identified as heterosexual, 35% identified as
gay/lesbian and 25% identified as bisexual. Participants
spent an average of 12.25 hours per week engaged in
OSA. Overall, bisexual males were significantly more
likely than heterosexual and gay males to be assessed as
being at high-risk of their OSA interfering and jeopardizing
important areas of their life (i.e., social, occupational and
educational). Gay and bisexual males were significantly
more likely than heterosexual males to meet someone
offline that they first met online, however sexual
orientation was not related to offline meeting behaviour
for female participants. Increases in depression, anxiety,
stress, emotional and social loneliness and impulsivity
were associated with increased engagement in OSA for all
participants, regardless of sexual orientation.
174
PA 01-02
Dyadic coping in intimate relationships:
The association between dyadic coping and
relationship quality and its implications for
therapy
Mireille Ruffieux1
1
University of Zurich, Switzerland
Common and mutual supportive stress management has
an important role in intimate relationships. A series of
studies has shown that dyadic coping is associated with
an increased relationship quality and a more favorable
course of relationship (e.g. Bodenmann, Pihet, & Kayser,
2006; Pasch & Bradbury, 1998). In a 5-year prospective
study, stable-satisfied couples could be distinguished
from stable-distressed and separated/divorced couples
by higher values in dyadic coping (Bodenmann & Cina,
2006). Dyadic coping serves two functions: reduction
of stress level, and strengthening the sense of unity
and mutual trust in a couple (Bodenmann, 2004). This
longitudinal study comprising 360 couples investigates
the association between dyadic coping and relationship
satisfaction in three age groups (1st cohort: 20- to 35year old, 2nd cohort: 40- to 55-year old, 3rd cohort: 65to 80-year old). Couple-relat ed self-report data as well
as observational data are the basis for analyses. It will
be examined to what extent dyadic coping is related to
relationship satisfaction dependent on gender, age group,
and duration of relationship. Results indicate that dyadic
coping is associated with higher relationship satisfaction
in all age groups. In addition, differences in dyadic coping
as a function of duration of relationship, age group, and
gender can be shown. Implications for couple therapy,
especially for older couples, are being discussed
EABCT 2012
EABCT 2012
PA 02-01
A randomized controlled trial of Cognitive
Behavioral Therapy to improve depression in
adults with epilepsy
Milena Gandy1; Louise Sharpe1; Kathryn Nicholson
Perry2; Zoe Thayer3; Laurie Miller3; Janet Boserio3 ;
Sydney Armin3
1
The University of Sydney, Australia; 2The University
of Western Sydney, Australia; 3The Royal Prince Alfred
Hospital, Australia
Introduction: Up to 50% of people with epilepsy (PWE)
will develop a depressive disorder over their lifetime.
Objectives: Our analysis of 130 consecutive adults with
epilepsy attending a large. Tertiary referral hospital in
Sydney Australia found 26% of the sample met criteria
for a DSM-IV-TR depressive disorder and 33% reported
some suicidal risk. Despite the high proportion of PWE
who experience depression, a recent Cochrane Review
confirmed that there is currently no evidence-based
psychological intervention. One reason for the lack of
effectiveness of previous trials may relate to the fact that
they have not targeted empirically supported predictors of
depression.
Methodology: We performed a cross-sectional analysis
of 75 adults with epilepsy and found coping style and
degree of enmeshment between self and illness predicted
low mood. Using this information, we developed an eightweek, individual-based CBT program tailored to improving
mood and quality of life in PWE. Fifty eight patients with
epilepsy were randomized to receive either CBT (n=31) or
to a Wait-list control (n=27).
Results: As in prior trials, drop-out rates from CBT were
high (9/31; 29%). PWE who had lower epilepsy selfefficacy (t (51)=2.17, p<.05), were more likely to dropout of treatment. However, for those who completed CBT,
significant improvements were found on the Neurological
Depressive Disorders Inventory for Epilepsy; (F (1,37)
=5.079, p=0.030) and the Hospital Anxiety Depression
Scale – Depression subscale; (F (1,37) =54.32, p=0.045).
However, improvements were not observed for anxiety or
quality of life.
Conclusions: Nonetheless, these results suggest
that CBT can be effective in improving mood for PWE.
However, those with low levels of self-efficacy may need
an approach that specifically targets self-efficacy in order
to increase the chance of completing the program.
175
2
Early maladaptive schemas and extradyadic
involvement in dating relationships
Marco Pereira1; Alexandra Martins1; Frank Dattilio2; Isabel
Narciso3;
Maria Canavarro1
1
University of Coimbra, Portugal; 2 Harvard Medical
School, Boston, USA; 3University of Lisbon, Portugal
Introduction: There is a growing body of research
on schemas and relationships, however, no studies
have related infidelity/extradyadic involvement to early
maladaptive schemas (EMS).
Objectives: The purpose of this study was to examine
the EMS, as delineated by Young, associated with faceto-face and online extradyadic behaviors (EDB) in dating
relationships.
Methodology: The sample comprised 338 women
and 156 men between the ages of 18 and 43 years
(M=23.38, SD=3.41) who were currently in a dating
relationship of at least three months (M=34.88 months;
SD=25.68). Participants completed measures pertaining
to maladaptive schemas (YSQ–S3), and extradyadic
behaviors (Extradyadic Behavior Inventory).
Results: The self-reported involvement on face-to-face
EDB was of 63.5% for men and of 56.5% for women. The
involvement on online EDB was of 46.2% for men and of
39.1% for women. Overall, those who reported face-toface extradyadic involvement showed higher scores in 15
of 18 EMS, and those who reported online extradyadic
involvement showed higher scores on 17 of 18 EMS. In
the regression analysis, among men, higher scores on
emotional deprivation and approval seeking, and lower
scores on punitiveness were associated with face-to-face
extradyadic involvement; lower scores on abandonment
and punitiveness were associated with online extradyadic
involvement. Among women, higher scores on
dependence/incompetence and insufficient self-control,
and lower scores on approval seeking were associated
with face-to-face extradyadic involvement; higher scores
on mistrust/abuse and insufficient self-control, and lower
scores on enmeshment/undeveloped self were associated
with online extradyadic involvement.
Conclusions: Our findings suggest gender-specific
patterns in the association between EMS and extradyadic
involvement. These findings provide valuable information
about the nature of dating relationships, which also could
lead to applications in the field of couple’s therapy.
Paper Session 2 - CBT for people with
neurological comorbidities
Papers
PA 01-03
Papers
2
PA 02-02
PA 02-03
RCT of Guided CBT self-help resources for
medically unexplained neurological symptoms
Christopher Williams1; Michael Sharpe2; Alan Carson3;
Catriona Kent4; Jane Walker5; Jon Stone3; Jonathan
Smith6; Rod Duncan7; Gordon Murray5; Isabella Butcher5
1
Institute of Health and Wellbeing, United Kingdom;
2
University of Oxford, United Kingdom; 3University of
Edinburgh, Royal Edinburgh Hospital, United Kingdom;
4
NHS Greater Glasgow and Clyde, United Kingdom;
5
University of Edinburgh, United Kingdom; 6NHS Lothian,
Psychiatry, United Kingdom ; 7NHS Greater Glasgow and
Clyde, United Kingdom
Objectives: Functional (psychogenic or somatoform)
symptoms are common in neurology clinics. Cognitivebehavioral therapy (CBT) can be an effective treatment,
but there are major obstacles to its provision in practice.
We tested the hypothesis that adding CBT-based guided
self-help (GSH) to the usual care (UC) received by patients
improves outcomes.
Methods: We conducted a randomised trial in 2 neurology
services in the United Kingdom. Outpatients with functional
symptoms (rated by the neurologist as “not at all” or only
“somewhat” explained by organic disease) were randomly
allocated to UC or UC plus GSH. GSH comprised a self-help
manual and 4 half-hour guidance sessions. The primary
outcome was self-rated health on a 5-point clinical global
improvement scale (CGI) at 3 months. Secondary outcomes
were measured at 3 and 6 months.
Results: In this trial, 127 participants were enrolled, and
primary outcome data were collected for 125. Participants
allocated to GSH reported greater improvement on the
primary outcome (adjusted common odds ratio on the CGI
2.36 [95% confidence interval 1.17–4.74; p_0.016]). The
absolute difference in proportion “better” or “much better”
was 13% (number needed to treat was 8). At 6 months the
treatment effect was no longer statistically significant on
the CGI but was apparent in symptom improvement and in
physical functioning.
Conclusions: CBT-based GSH is feasible to implement
and efficacious. Further evaluation is indicated.
The trial is published (Sharpe et al 2011) and has led to the
linked resource manual becoming the recommended Step
2 intervention for such disorders in Scotland (HIS, 2012).
Acknowledgement: The study was funded by the MRC
The use of a cognitive-behavioral group
approach in managing anger after a traumatic
brain injury
Tatiana Aboulafia Brakha1; Carole Greber Buschbeck1;
Lucien Rochat2; Jean-Marie Annoni3; Laurie Miller2; Janet
Boserio2; Sydney Armin2
1
Geneva University Hospitals, Switzerland; 2University of
Geneva, Switzerland; 3University of Fribourg, Switzerland
Introduction: Behavioral dysfunctions such as
disproportional anger and aggressiveness are frequently
observed after a traumatic brain injury (TBI). These
maladaptive behaviors can disturb general social, academic
and professional insertion with further decrease in quality
of life. Individual cognitive-behavioral interventions
have proven to be effective in reducing anger in chronic
TBI patients but group approach have been described in
a lesser extent. The latter allows exchanges of personal
experiences and cutting-off treatment costs.
Objectives: verifying the feasibility and usefulness of an
anger management protocol based on cognitive-behavioral
frame-work held in small grou ps of chronic TBI patients.
Methods: Assessment of self-rated measures of
aggressiveness (AQ-12) before (T1) and after (T1) an
intervention protocol focused on managing emotions
related to aggressiveness. The program consisted of eight
once-a-week meetings held mainly in small groups and
focused on self-awareness and self-monitoring, managing
emotions in emergency situations, cognitive restructuring
and prevention strategies.
Results: participants with higher (“High AQ-12”) and
lower scores (“Low AQ-12”) on AQ-12 on T1 were
divided into two groups (median split) and did not show
further statistical differences on other behavioral and
neuropsychological variables, nor on demographic and
clinical characteristics. In T2, “High AQ-12” showed a
significant reduction on AQ-12 scores while no significant
changes were found in the “low AQ-12” group.
Conclusions: cognitive behavioral group approach for
managing anger and aggressiveness in TBI was feasible
and showed positive results especially in patients reporting
higher levels of aggressiveness. Those findings suggest
that routine clinical intervention should be encouraged
even though further research with larger samples and
better experimental designs are still needed.
References:
HIS (2012). Stepped care for functional neurological symptoms:
www.healthcareimprovementscotland.org/programmes/long_term_
conditions/neurological_health_services/neurological_symptoms_
report.
Sharpe et al (2011) Neurology. 77(6), 564-72 DOI 10.1212/
WNL.0b013e318228c0c7
176
EABCT 2012
Spiritual intelligence, Meta-cognitive beliefs and
Life expectancy and their interaction between
MS patients and healthy ones
Neda Ali Beigi1; Nikta Nazemi Zand2; Fariborz Bagheri2
1
University of social welfare and rehabilitation sciences,
Tehran, Iran; 2Tehran Azad University, Iran
Introduction: Multiple Sclerosis (MS) is one of the
most disabling disease among young adults, which is
a chronic degenerative disease of the central nervous
system. Fatigue and depression are main symptoms which
reduce quality of life. The main objective of this study
was comparison of spiritual intelligence, meta-cognitive
beliefs, life expectancy and their interaction between MS
patients and healthy ones.
Method: It was a post- facto research. From the MS
patients who referred to the Iranian MS Association, 90
patients were selected by random sampling and 90 healthy
persons were also selected as the control group. The
participants were assessed by questionnaires of spiritual
intelligence, meta-cognitive beliefs and life expectancy.
Findings: T - test used for independent groups to compare
MS patients with healthy ones. Regression analysis used
for correlation and power of prediction. Results showed
that there was a significant difference between spiritual
intelligence of the MS patients and the healthy ones.
Also, there was a significant difference between negative
meta-cognitive beliefs about anxiety (uncontrollability)
and low cognitive efficiency. There was no significant
difference in life expectancy of the two groups. Correlation
showed that there was a significant difference between
spiritual intelligence and life expectancy; which means
by increasing spiritual intelligence, life expectancy will
increase.
Discussion: Results showed generally, spiritual
intelligence predicts 36.6% of life expectancy variance.
There were relationships between positive meta-cognitive
belief about anxiety, negative meta-cognitive belief about
anxiety (uncontrollability), low cognitive efficiency and
negative meta-cognitive belief about thoughts and life
expectancy; It means reduction of these beliefs will
increase life expectancy. Results indicated meta-cognitive
beliefs predict 26.1% of life expectancy variance.
Effectiveness of Cognitive–Behavioral Intervention
on Psychological and Social Aspects of Multiple
Sclerosis: A randomized control trial with followup
Sara Banihashemi1; Ladan Fata2
1
Segal CBT center, Iran; 2Tehran University of Medical
Sciences (TUMS), Iran
Introduction: CBT has been used since 1950s for treating
various problems including psychological problems due
to medical conditions. Considering the role of stress in
aggravating Multiple Sclerosis (MS), the current study
examines the effectiveness of a cognitive behavioral based
stress management program on psychological syndromes
and social aspects of MS in women.
Methodology: 31 sufferers of MS were randomly
assigned into experimental and control groups. Both
groups answered “Iranian Quality of Life Questionnaire”,
“General Health Questionnaire”, “Coping Response
Inventory” and “Depression, Anxiety, and Stress Scale” in
pretest, post-test, and 6 month-follow-up. Experimental
group attended a 10-session, (2.5 hours each session)
workshop of cognitive-behavioral stress management. At
the end of intervention, two groups answered the same
questionnaires. Data analyzed using repeated measures
analysis of variance and two groups were compared at pretest, post-tests, and follow-up. In this analysis CBT based
stress management program was independent variable
and subscales of each measure were dependent variables.
Results: Cognitive behavioral stress management
program was successful, resulting in significant change
in general mental health (F = 25.83, 0.001), stress (F =
17.14, 0.001), anxiety (F = 5.81, 0.02), depression (F =
26.43, 0.001), quality of life (F = 27.55, 0.001), emotion
oriented copings (F = 18.52, 0.001) and problem oriented
copings (F = 15.65, 0.001) variables, both in post-test and
6-month follow-up, however no significant difference was
found in social support coping strategy variable (F = 1.14).
Conclusion: The current study indicated that Cognitive–
Behavioral based stress management program is a useful
program for reducing stress, raising the quality of life,
and enhancing adaptive copings of patients suffering
from MS. These results are congruent with CBT model of
psychological problems.
EABCT 2012
177
2
PA 02-05
Papers
PA 02-04
Paper Session 3 - Depression: Basic
processes and treatment
PA 03-01
Papers
3
Can ‘self-confidence workshops’ provide a more
accessible and effective psychological treatment
for depression?
June Brown1
1
Kings College London, United Kingdom
Introduction: Only about 40% with depression seek
help. To improve access, a low intensity CBT treatment
was developed, called ‘self-confidence’ workshops rather
than depression workshops.
Objectives and Methodology: This RCT aims to
investigate the clinical benefits and costs of this approach
for depressed people. This study aims to assess:
a) clinical outcomes, particularly depression and anxiety
b) the costs and cost-effectiveness of these workshops
c) characteristics of people who self-refer
Results: 459 depressed people self-referred. 25% of
those who self-referred had never seen their GP about their
depression. High numbers of BME groups also attended.
At 3 months’ follow-up, significant differences were
found between the experimental and control groups on
depression. Promising health-economic results were also
obtained.
Discussion/Conclusion: Self-confidence workshops
appear to be clinically effective at 3 months’ followup. They also attracted people who are reluctant to seek
help for depression. This may have the potential to be an
accessible and effective intervention for depression.
178
PA 03-02
Decentering mediates the effect of self-focused
processing modes in depression
Cola Lo1 ; Samuel Ho2
1
Castle Peak Hospital, Hong Kong, China; 2City
University of Hong Kong, China
Modes of self-focused processing have been found to
have distinct impacts on depression, in which ruminative
processing was found to be maladaptive, whereas
experiential processing was more adaptive in depression.
However, the underlying mechanism for the differential
effects was under-investigated. Decentering, representing
the capacity to take a present-focus, nonjudgmental
stance in regard to thoughts and feelings, which has
been found to be an important potential mechanism of
change in cognitive therapy, was hypothesized to be
a mediator between the relationship of modes of selffocused processing and negative thinking in depression.
The present study investigated the effects of the two
distinct modes of self-focused processing (experiential vs
ruminative) on decentering and negative thinking in groups
of depressed patients and dysphoric college students
in Hong Kong. Seventy-five participants were randomly
allocated into two experimental conditions in which
modes of processing were manipulated. Two identical sets
of questionnaires measuring mood states, decentering
and negative thinking were completed before and after the
experiment. The results supported the differential effects of
these two processing modes on decentering and negative
thinking. Furthermore, regression analysis and test of
indirect effect supported decentering as a mediator in the
relationship and decentering at least partially accounted
for the effects of processing modes in depression. The
treatment implications of the results would be discussed,
specifically on the potential benefits of mindfulness
training to people with depressed problems.
EABCT 2012
Complicated Grief in a Private Psychiatrist’s
Clinical Practice: a 13-year Retroactive Data
Study
Alain Sauteraud1
1
Private Practice, Bordeaux, France
The prediction of depressive symptomatology: A
longitudinal study
Ana Matos1; Ceu Salvador1; Catia Ribeiro1; Sonia
Cherpe1; Eirikur Arnarson2; Edward Craighead3
1
University of Coimbra, Portugal; 2Lanspítali University
Hospital, Iceland; 3University of Emory, USA
Since the 90’s, most researchers agree that the loss by
death of a beloved can cause a specific mental disorder.
Although researchers don’t definitely agree on criteria
for diagnosis, the identification of complicated grief is
based on the coexistence of 1) yearning for the deceased
and 2) depressive and/or traumatic symptoms focused
on the circumstances of the death of the loved person
and life without him or her. According to recent studies,
this disorder may account for 1% to 4% of the general
population. The focus of the present study is to determine
the frequency and the treatment of grief problems in an
adult psychiatry private office, specialised in anxiety and
depressive disorders. Retroactive data during a 13-year
period has been systematically studied. Among people
who come for the first time to the office, grief problems
are the main reason of help-seeking in about 2% of the
patients. Death of a first degree relative or spouse is the
cause of the distress. Patients’ consultations usually
occur late after the death, from six months to several
years. According to existing scientific data, cognitive and
behaviour therapy (CBT) has been mainly provided for
these patients. Medication and supportive psychotherapy
may help in some situations too. Even if CBT treatment
of depressive or traumatic problems has been well
documented, yearning necessitates a specific approach.
By proposal of the author, it consists in 1) integration in
the grieving person’s daily life of positive aspects of the
experiences shared with the deceased; 2) establishing
specific moments or precise locations for reminders
of the beloved; 3) integration of the loss by death in the
survivor’s life. Naturalistic data of the population issued
from the clinical experience of the author and results of
these therapeutic interventions will be developed.
EABCT 2012
Empirical evidence has demonstrated the increasingly
early onset of depression. When the first depressive
episode occurs in adolescence, depression tends to
assume a chronic course, getting worse over time, and
interfering significantly in several areas of functioning.
The prevalence of this clinical disorder has been
increasing and has important personal and economic
costs. Paradoxically, research on the etiopathogenesis of
depression is still short and has several methodological
limitations, so further studies are needed to understand
the mechanisms by which risk and protective factors act
to increase or decrease the predisposition to develop
depressive symptoms.
Therefore, this investigation, making use of a longitudinal
approach (over a period of 12 months), aimed to study
some predictors of depression (depressive symptoms,
life events, emotional regulation strategies and subjective
well-being) and their effect on the onset of this clinical
disorder, exploring the hypothesis that emotional
regulation strategies are meditational variables. The
sample consisted of 182 adolescents aged between 12
and 16.
Surprisingly, although the explanatory model of this
study explains 43% of the variability of depression,
life events had no predictive power on depressive
symptomatology. The previous depressive symptoms
were the best predictor of depressive symptoms. The
catastrophizing and brooding (measured at time 1) also
had a predictive effect, although indirect, mediated by
brooding (time 2). The psychological well-being was
the only dimension of well-being that showed an effect
of prediction.
These results suggest the importance of prevention and
early intervention in depressive symptoms, by focusing
the intervention on specific aspects of rumination and
subjective well-being.
179
3
PA 03-04
Papers
PA 03-03
PA 03-05
PA 03-06
A pilot study on the effectiveness of a cognitive
behavioral group program to enhance selfesteem and a sense of mastery in distressed
women students
Johanna Bernhardsdottir1; Runar Vilhjalmsson1; Jane
Champion2; Ingela Skärsäter3
1
University of Iceland, The National University Hospital of
Iceland, Iceland; 2Texas Tech University Health Sciences
Center, USA; 3University of Gothenburg, Sweden
Do Existence Observation Effect(EOE) works for
Mood Disorders?
Hassan Bashiri1; Usha Barahmand1, Mostafa Boluki1;
Maryam Boluki1; Marieh Dehghan1; Nasrin Abbasi Tehrani1
1
Hezareh International Family Health Organization, Tabriz,
Iran
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Introduction: Women are 62% of the student body in
Icelandic universities and perceive significantly higher
stress than the general population. Almost 34% feel they
have been under much or very much stress for the past
year, and 28% feel they need mental services.
Objectives: Based on these results a CBT program was
formulated for distressed women students to enhance selfesteem and sense of control.
Methodology: The program was pilot tested and provided
to a sample of 19 women between 22-45 years of age
representing most faculties. The intervention was carried
out in 4 weekly group sessions. They were facilitated by
two advanced practice psychiatric nurses and five to eight
women were enrolled in each group. The effectiveness of
the program was evaluated with pre, post and follow-up
design and qualitative interviews asking participants about
their experiences concerning participation in the program.
The effectiveness was assessed with Rosenberg Selfesteem Scale and Pearlin´s Mastery Scale.
Results: Results showed significant improvement in selfesteem and sense of control from pre-treatment to 7 month
follow-up. These improvements were reflected in the
qualitative content analysis where the women expressed
three main benefits of the intervention: To gain knowledge
and understanding, to become more positive in thinking
and to feel more in control. Finally the women expressed
a need for more opportunities for in depth reflections
and exercise of CBT techniques in one or two additional
sessions.
Discussion: Self-esteem and sense of control are key
resources that enable a person to meet challenges in
everyday life. This mixed method study shows that the
CBT program was effective in enhancing these resources
among university women students.
Conclusion: Self-esteem and sense of control in women
students can be enhanced through CBT techniques.
For further evaluation of the program a large-scale
experimental study is needed.
Presentation cancelled du to VISA refusal
The «Existence Observation Effect(EOE)» introducing
by this reaserach is a creative technique in CBT based
treatments which assumes that if clients according to a
special programming, do something to see them selves
as a person who is able to influence their environment,
their impaired self consciousness will improve and their
depression scores will decrease. In this research 15 mild
to moderate depressive clients were exposed to «EOE
package». Post test results showed a significant decrease
in Their Beck Depression Inventory ( BDI) scores. It is
concluded that EOE can be useful in reducing depression,
increasing pleasure and hope and improving self image in
clients with mood disorders.
EABCT 2012
What dreams may come: Emotional cascades
and nightmares in borderline personality
disorder
Edward Selby1; Jessica Ribeiro2; Thomas Joiner2
1
The State University of New Jersey, USA; 2Florida State
University, USA
People diagnosed with borderline personality disorder
(BPD) have been found to have a number of sleep
problems, including frequent and distressing nightmares.
The experience of nightmares is likely to worsen emotion
dsyregulation and decrease coping abilities the subsequent
day, making it an important issue for clinicians to address.
One recent theoretical model of BPD psychopathology,
the Emotional Cascade Model (ECM), may shed light on
this phenomenon by characterizing nightmares as the
experience of emotional cascades that occur during sleep.
A model is presented in which these cascades may carry
over from a stressful day and lead to elevated cognitive
activity during sleep, as well as nightmare-like phenomena.
To test this model we used experience sampling from 47
participants exhibiting dysregulated behaviors – 16 of
them diagnosed with BPD. Negative emotion, rumination,
and number of nightmares were assessed daily across two
consecutive weeks. Analyses indicated that the BPD group
experienced more frequent nightmares, that BPD diagnosis
interacted with baseline trait rumination to prospectively
predict number of nightmares reported during monitoring,
and daily experience of emotional cascades predicted
subsequent number of nightly nightmares. These findings
held after controlling for key covariates, including sleep
quality and diagnoses of depression and posttraumatic
stress disorder. Important clinical interventions consistent
with the ECM conceptualization of nightmares are
proposed, including the potential for management of daily
rumination and negative emotion, imagery rescripting
for recurrent or anxiously anticipated nightmares, and
potential prescription of prazosin (an alpha1-adrenergic
antagonist) for the reduction of nightmares in this group.
EABCT 2012
Are narcissists really healthy? A discussion
about diagnostic criteria
Eva Schürch1; Carolyn Morf1; Robert Mestel2 1
University of Bern, Switzerland; 2Helios Klinik Bad
Grönenbach, Germany
Introduction: While narcissistic personality disorder
(NPD) is rare in clinical settings there are numerous people
with narcissistic personality traits among patients and
the normal population. These grandiose and exploitative
people usually report high well-being and low symptoms.
However, if the more vulnerable aspects are measured,
narcissists appear to suffer from various Axis I disorders
or symptoms.
Objectives and methodology: In this study we examined
the relation between narcissism and psychological wellbeing in a large community sample (N=1837) and a clinical
sample (N= 219 inpatients). Participants completed online
questionnaires assessing different aspects of narcissism
and various other personality and psychopathology
measures.
Results: Grandiose narcissism (as measured with the
DSM based Narcissistic Personality Inventory NPI, Raskin
& Terry, 1979) positively correlates with self-esteem,
secure attachment, satisfaction with life, and professional
success. In contrast, we found negative NPI correlations
with symptoms (SCL-90), depression, and interpersonal
problems. Vulnerable narcissism (as measured with the
Pathologic Narcissism Inventory NPI, Pincus et al., 2009)
correlates positively with the SCL-90 global severity
index, borderline personality disorder, depression,
anxious and avoidant attachment, interpersonal problems
etc. Additionally, inpatients have significantly lower values
in grandiose narcissism and higher values in vulnerable
narcissism than the normal population.
Discussion and conclusion: Whereas grandiose
narcissists rarely search psychological help, their more
vulnerable counterparts are much more likely to show up
in therapeutic settings. It therefore seems crucial to apply
different diagnostic criteria to identify them and better
understand their comorbid disorders.
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Paper Session 4 - Personality Disorders:
Sleep, relationships and diagnosis
questions
PA 04-04
The Role of Personality in Insomnia
Clint Gurtman1 ; Rachel McNicol1 ; Jane Mc Gillivray1
1
Deakin University, Victoria, Australia
Approximately one third of the adult population experience
insomnia, with 6% meeting formal DSM-IV diagnostic
criteria. The impact of insomnia is evident in a variety of
areas, including an increase in psychological distress,
reduced quality of life, higher health care costs, increased
absenteeism at work, and a higher incidence of psychiatric
problems. The etiology of insomnia is still not entirely
understood and is likely to be multifaceted. There is,
however, increasing emphasis placed on the role of
psychological factors, and this has lead to the development
of target cognitive behavior therapies. An understudied
area in the etiology of insomnia is the predisposing and
perpetuating role that personality may play. Previous
research suggests that individuals with insomnia are
prone to handle conflict and stress by using emotionorientated coping strategies. Further, they appear to have
a perceived lack of control over stressful events, which
subsequently elevates arousal. Such findings suggest
that personality may play a role in the development and
maintenance of insomnia. In the present study, males and
females aged 18-60 experiencing clinically significant
insomnia participated in a 30-minute internet-based
assessment consisting of standardized measures of
personality, insomnia severity, beliefs and attitudes about
sleep, pre-sleep arousal, and negative affect. Participants
were recruited from sleep clinics, general practice and
psychology clinics, and via the Internet. Results from Path
Analysis suggest that Neuroticism may play a role in the
severity of insomnia through its relationship to pre-sleep
arousal, negative affect, and problematic sleep-related
cognitions. The implications of these results for current
CBT approaches to treating insomnia will be discussed.
Other findings, such as pre-sleep activities, psychiatric
problems and the use of sleep medications, and how they
may be relevant to treatment, are also briefly considered.
Dyadic coping and commitment in the intimate
relationships of narcissistic individuals
Mirjam Kessler1; Guy Bodenmann1; Fridtjof Nussbeck1;
Dorothee Sutter-Stickel1
1
University of Zurich, Switzerland
Commitment is one of the most important predictor
for the duration of intimate relationships. According to
the investment model of Rusbult individuals become
increasingly dependent on their relationships and,
consequently, show higher commitment. Commitment is
positively associated with relationship satisfaction and
the size of the investment in relationship but negatively
with perceived desirability and quality of the best available
alternative.
Commitment can be distinguished in different components.
In this study for the first time we differentiate in emotional,
cognitive and sexual commitment. In couple study (N =
360 couples) of three age cohorts (20-35, 40-55, 65-80
years) we examined commitment, satisfaction level, dyadic
coping, and personality traits like narcissism by means of
questionnaires.
The distinction in emotional, cognitive and sexual
commitment was empirical confirmed. The internal
structure of commitment in its three factors differentiated
in the three different age cohorts. There is explanatory
power of the three components concerning satisfaction
level of the intimate relationship especially regarding
narcissistic personality.
These findings are discussed regarding the significance
of couple therapy as not only working on the commitment
of a couple has a high priority but also the awareness that
narcissism of one or both partners have a high impact of
the success if a therapy.
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PA 04-03
Short-term effectiveness of outpatient CBT
under clinically representative conditions: A
naturalistic study with waiting control group
Birgit Watzke1; Katja Apel1; Ulrike Lupke2; Helmut Peter2;
Levente Kriston1; Holger Schulz1
1
University Medical Center Hamburg-Eppendorf,
Germany; 2Verhaltenstherapie Falkenried MVZ, Hamburg,
Germany
Introduction: Although effectiveness research has received
more attention recently, studies investigating outcome
under clinically representative conditions are still required
(Lambert & Ogles, 2004). Studies conducted in clinical
routines usually cannot refer to designs, which include
untreated controls because of clinical and ethical reasons
(e.g. mandate to supply care). Therefore, evidence is
primarily based on pre-post-comparisons within one group.
Given the long waiting period of ca. 6 months before
beginning treatment within German mental health care
we refer to such a “naturalistic” waiting control group
(WCG): With such a group it is possible to investigate the
effectiveness of outpatient cognitive behavioural therapy
(CBT) for the first phase of treatment and to investigate
the question what treatment effects patients can achieve
during a period of time in which a large percentage of
patients still have to wait for CBT.
Methodology: We included a consecutive sample of
patients seeking for CBT at an outpatient unit. Due to a
special contract of integrated care between this unit and
some (but not all) health insurances, patients received
either CBT immediately (intervention group, IG, n = 71)
or – in case that their health insurance was not a contract
partner - had to wait for CBT (WCG, n = 74). The primary
outcome was defined as change in symptom severity
(HEALTH-49) from t0 (baseline) to t1 (6 months after
baseline). The secondary outcome referred to health
related quality of life (SF-8).
Results: The ANCOVAs reveal significant differences
with small effect size indicating that patients of the IG
show better treatment effects than patients of the CG
(symptom severity: p = .025; ç² = .035).
Discussion: Our results indicate that CBT is already
effective in an early phase of treatment. The results are
discussed taking into account potential limitations (e.g. no
randomisation) as well as potential strengths (e.g. external
validity) of the study.
EABCT 2012
CBT with Ultra-Orthodox Jews: A Tale of two
Hassidim
Baruch Greenwald1
1
Beer Yaacov Ness Ziona Mental Health Center, Israel
Introduction: The Hasidim, or «pious ones» in Hebrew,
belong to a special movement within Orthodox Judaism.
The Hasidic ideal is to live a hallowed life, in which even
the most mundane action is sanctified.
For most of the 20th century members of Hasidic sects
rarely saw psychotherapists, but recently the training of
more observant and ultra-orthodox Jews as therapists,
as well as an overall opening up to the advantages of
therapeutic interventions within these communities has
led to a major increase in clients from this sector.
Objectives and Methodology: This presentation
describes the cases of two Hassidic men treated by the
author. Both were young men in their 20s, sons in large
Hassidic families, from different sects. Both suffered from
compulsive behaviors and violent outbursts. While one
man found a real connection between CBT and traditional
Jewish texts that were used in therapy, the other man
found CBT contradictory to his belief that the example
set in Hassidism by the Rebbe (traditional leader) meant
that perfection should be his goal with no compromise.
Treatment objectives for both cases were to eradicate the
unwanted behaviors while remaining within the appropriate
religious framework. This was done by both utilizing and
challenging the clients’ orthodox thinking.
Results: In both cases, many unwanted symptoms
disappeared and although some remained, both clients
appreciated the rationale of CBT and were now able
to independently utilize techniques they had learned.
Treatment did last longer than usually expected with CBT,
24 and 32 sessions.
Discussion and Conclusion: Passages from the Talmud
and other medieval texts supplemented Beck and Burns.
Cognitive Behavior Therapy can be seen as universal in
nature and with the appropriate.
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Paper Session 5 - CBT in different context
and professional issues
PA 05-04
CBT for people in transition: Conceptual and
practical differentiations
Moshe Israelashvili1
1
Tel Aviv University, Israel
The nature and qualifications of Adjustment disorders (e.g.,
as defined in the DSM) are still unclear and hence need
further explorations. In the presentation, a comprehensive
approach to counsel people in transition would be
presented. Based on this approach, it would be suggested
that helping people in transition requires an identification of
the source, or combination of sources, that have led to the
adjustment problem first, followed by the implementation of
an adequate helping approach. For example, a differential
definition of the terms adjustment, adaptation, socialization
and coping is required in order to better define the type of
demand that is imposed on an individual who encounters a
transitional event. Moreover, assuming that the four types of
demands might be the possible sources of maladjustment,
each type of demand would require a different CBT approach.
Implications for the differential use of various approaches to
CBT, within and between different phases and circumstances
of the transition process, would be exemplified and detailed
with reference to immigrant adolescents. The presentation
would be concluded by a presentation of the results of an
evaluation study, in which coping and adjustment feelings
of immigrant adolescents (N= 41) were compared, pre-post
intervention, to those of a control group (N= 46).
CBT and interpersonal strategies for migrants
Abdelhak Elghezouani1
1
Association APPARTENANCES, Lausanne, Switzerland
The specificities and complexity of the psychological
problems encountered in our Psychotherapeutic
Consultation for Migrants involves the development and the
implementation of particular and integrated relational and
therapeutic strategies. They lean on strategies favouring the
patient’s adherence to therapy and centres on his concrete
needs. The « theory » of needs constitutes the foundation of
our model whose operational plan bases it self on methods
developed within the framework of cognitive and behavioural
therapies.
This model includes two sides and a base: the Plan
analysis, the Functional analysis and the needs. The theory
of needs supplies a new paradigm in line with the life and
world conceptions, needs and resources of the patients. It
allows the mobilization of psychical, emotional, cognitive,
self-observative and analytical contents and abilities of
the patient, more « natural and respectful of the cultural
and social characteristics of the patients. It bases itself
on the need of meaning and coherence of the individuals,
and on their recognition by the therapist. The symptoms
are construed as the expression of dissatisfied needs
and as strategies to satisfy them. These strategies give
rise to particular ways of adaptation, which are identified,
analysed and discussed during the therapy.
In this framework, behavioural and cognitive techniques,
Plan analysis and Functional analysis become
complementary psychotherapeutic means. The functional
analysis allows a synchronous reading giving meaning
to what had previously none. The analysis of the plans
puts back an «existential» dimension (the needs), both
subjective and constructive. Techniques inspired drowned
from Functional Analytical Therapy emphasises what
occurs during the therapy, and within the therapeutic
relationship and favours the complementary patienttherapist relationship.
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Treatment of dental phobia at the University of
Bern, Switzerland
Alessandra Colombo1 ; Norbert Enkling1 ; Franz Caspar1
1
University of Bern, Switzerland
Introduction: Fear of dental treatment is a widespread
disorder. 80% of adults in developed countries show
discomfort when treated by a dentist while 20% show a
high degree of anxiety and 5% completely avoid dental
care. Generally, dental fear arises in the adolescence and
can become chronic in the young adulthood.
Objectives and Methodology: The objective of
collaboration between the Department of Clinical
Psychology, Outpatient Clinic, at the University of Bern
and the School of Dental Medicine, Department of
Prosthodontics, was to implement a treatment protocol for
the cure of dental phobia in order to decrease the need for
general anesthesia during dental treatment.
Results: Based on the short-term treatment program of
Sartory & Jöhren (2002), cognitive-behavioral methods
as well as relaxation and suggestive therapies were
implemented in a three- sessions treatment protocol.
The first session included the exploration of the patients’
phobia and the instructing of the progressive muscle
relaxation therapy (PMR). The second session included the
development of an anxiety hierarchy and its processing,
the writing of the patients’ requests for the dentist to
accept, and the exposure to phobia in sensu. The third
session was scheduled at the school of dental medicine
where the patients were accompanied by the psychologist
while meeting with the dentist and exposed to the phobia
in vivo.
Discussion: The collaboration of this treatment protocol
was successfully implemented and practiced. Most
of the patients could be cured from dental phobia and
continuously be treated by the dentist. Because the need
for control in most of dental phobic patients has been
wounded during dental visits in the past, our treatment
specifically aims to give the patients a feeling of control.
Conclusion: Our treatment protocol will be further
practiced. Future developments may include approaches
to additionally motivate phobic patients to participate in
our treatment program.
EABCT 2012
Automatic Avoidance Tendencies Predict
Physiological Fear Responses
Marieke Effting1; Katja Apel1; Ulrike Lupke2; Helmut
Peter2; Levente Kriston1; Holger Schulz1
1
University Medical Center Hamburg-Eppendorf,
Germany; 2Verhaltenstherapie Falkenried MVZ, Hamburg,
Germany
Objectives: Anxiety disorders are associated with biases
in automatic processes: Threat stimuli draw attention, are
automatically evaluated as negative, and trigger impulsive
avoidance tendencies. Current dual-system models
propose that automatic processes may specifically drive
spontaneous, uncontrolled components of behavior.
In line with this, previous studies found that implicit
measures of attentional bias and evaluation bias predicted
physiological fear responses but not controlled avoidance
behavior. The present study examined whether also
impulsive avoidance tendencies show specific predictive
power for automatically elicited fear responses. It was
hypothesized that avoidance tendencies would predict
physiological fear responses over and beyond explicit fear
ratings.
Methodology: In fifty-seven female participants with
varying levels of spider fear, an approach-avoidance
task (AAT) was used to measure automatic avoidance
tendencies in response to spider pictures. Spontaneous
fear responses were assessed by the eye blink startle
response toward spider pictures. Controlled avoidance
behavior was assessed with a behavioral approach test
(BAT) in which participants approached a spider. A
questionnaire of spider fear and arousal ratings of spider
pictures indexed explicit fear.
Results: The implicit measure of avoidance tendencies
outperformed explicit measures of spider fear in predicting
startle responding. By contrast, the explicit measures but
not the implicit measure predicted avoidance behavior to
a spider.
Discussion and conclusion: The results indicate that
implicit measures of avoidance tendencies may have
specific predictive power for spontaneous fear responses.
Possible future therapeutic directions for targeting
automatic avoidance tendencies will be discussed. Finally,
first findings from a study on a factor (working memory
capacity) that may moderate the predictive value of implicit
measures for fear behavior will be presented.
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Paper Session 6 - Anxiety: Phobia, panic,
fear and avoidance
PA 06-04
Panic self-efficacy as a mediator of anxietyrelated symptom change in cognitive behavioral
therapy for patients with panic disorder
Hanne Nørr Fentz1; Morten Jensen1; Mikkel Arendt2;
Nicole Rosenberg2; Mia O’Toole1; Esben Hougaard1
1
Aarhus University, Denmark; 2Aarhus University
Hospital, Denmark
Introduction: The efficacy of cognitive behavioral therapy
(CBT) for panic disorder (PD) is well-established, however,
a variety of cognitive models of PD suggest different key
mechanisms for improvement in panic symptom severity.
Clark’s (1986) widely recognized model emphasizes
that changes in catastrophic misinterpretations of
bodily sensations are responsible for reduction in panic
symptoms, while later cognitive models propose perceived
self-efficacy to cope with panic attacks as an important
mediator of outcome. Research on cognitive mediators
of CBT outcome has so far been scarce and inconclusive.
Objectives: This study investigates different cognitive
models of PD and the relative contribution of panic selfefficacy and catastrophic misinterpretations in predicting
anxiety-related symptom change.
Methodology: Fifty-one patients with a primary
diagnosis of PD, with or without agoraphobia, completed
measures of catastrophic misinterpretations and perceived
panic self-efficacy before 13 sessions of group CBT, and
a measure of anxiety-related symptoms (Beck Anxiety
Inventory) after each session.
Results: Anxiety-related symptoms improved significantly
during CBT, and there was a significant shift towards
both higher panic self-efficacy and lower catastrophic
misinterpretations from pre- to post treatment. Panic selfefficacy completely and unidirectionally mediated changes
in anxiety-related symptoms while no significant effect was
seen for catastrophic misinterpretations. Further cross-lag
panel analyses will be conducted.
Discussion: Perceived panic self-efficacy appears to be
a central component in the mechanisms of change in CBT
for patients with PD, why a cognitively based explanation
or model of PD could be strengthened by also including
cognitions of perceived control and panic self-efficacy.
Conclusion: Our findings point to the conclusion that CBT
for patients with PD works through cognitive mechanisms,
specifically perceived panic self-efficacy.
Extinction and Renewal of Avoidance Tendencies
towards Conditioned Cues
Angelos-Miltiadis Krypotos1; Marieke Effting1; Merel
Kindt1; Tom Beckers1,2
1
University of Amsterdam, The Netherlands; 2University of
Leuven, Belgium
Pavlovian fear conditioning constitutes one of the principal
experimental paradigms for the investigation of fear and a
model for the pathogenesis of anxiety disorders. Through
this paradigm, more light has been shed on how fear is
learned, extinguished as well as the corresponding neural
underpinnings. However, Pavlovian fear conditioning
research has largely neglected behavioral avoidance
tendencies, a core characteristic of all anxiety disorders.
We have recently demonstrated that Pavlovian fear
conditioning results in the acquisition of avoidance
tendencies towards fearful cues. In the present experiment,
we evaluated whether those avoidance tendencies can be
extinguished and subsequently renewed. Specifically, two
groups underwent a fear acquisition procedure in which
2D projections of one neutral geometrical object were
paired with shock (CS+), whereas projections of another
object were never paired with shock (CS-). Subsequently,
both groups underwent a fear extinction procedure during
which the same objects were presented without shock. In
order to test avoidance tendencies, participants performed
a Stimulus-Response Compatibility Task (SCRT) in which
they had to move a manikin towards and away from the
CS projections. Groups differed in the context they
performed the SRCT. Group ABB performed the SRCT in
the same context as fear extinction but different from fear
acquisition, whereas Group ABA performed the SRCT in
the same context as fear acquisition but different from fear
extinction. In line with our predictions, outcomes indicated
renewal of avoidance tendencies in the ABA group
compared to the ABB group. The present study provides
evidence that extinguished avoidance tendencies can be
renewed by a return to the initial fear acquisition context.
Implications of this research for the study of fear learning,
anxiety disorders, neurosciences and its clinical relevance
will be discussed.
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EABCT 2012
PA 07-01
Adjustment of the mindfulness approach to a
group of substance-dependent patients with
hyperkinetic disorder
Christine Davidson1; Philippe Maso1
1
MD Consultation, Geneva, Switzerland
The mindfulness approach has proven to be useful in the
treatment of depressed patients.
This model appeared very pertinent to use as an approach for
patients with hyperkinetic disorder.
It was adapted to this disorder and used over an 8 weeks
span for a group of patients with hyperkinetic disorder.
During this presentation, the adaptations of the program
and the results we found will be discussed.
PA 07-02
Self-esteem, self-efficacy, and resources in
adults with ADHD
Patricia Newark1; Marina Elsässer1; Rolf-Dieter Stieglitz1
1
Universitäre Psychiatrische Kliniken Basel, Switzerland
Adults suffering from attention deficit hyperactivity
disorder (ADHD) often experience a multiplicity of negative
life outcomes and underachievement. Interpersonal,
academic, and vocational difficulties, as well as psychiatric
comorbidity are particularly common in individuals with
ADHD. Consequently, the formation of the individual’s
self-esteem and self-efficacy is often affected. Conversely,
these individuals tend to possess specific internal
resources, such as enhanced creativity or resilience.
So far, however, very few studies have considered this
perspective, and consequently results with respect to the
resources of adult ADHD are still owing, or inconclusive.
The purpose of this study is to shed light on therapy
relevant factors, such as self-esteem, self-efficacy, and
resources in adults with ADHD in comparison with adults
in a healthy control group. Additionally, participants’
general psychological distress level and its correlation
with aforementioned factors was assessed.
43 adults who met DSM-IV criteria for ADHD in adulthood
(outpatient sample) were matched with a non-clinical
sample in terms of age and gender. All participants (N= 86)
were assessed with self-ratings: Symptom Checklist (SCL90-R), Rosenberg Self-esteem Scale, General Perceived
Self-Efficacy Scale, Dick’s Resources Checklist, and (only
for the control group) the WHO-Screener (ASRS-v1.1).
Results showed that adults with ADHD have lower levels
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Fearfulness during full-blown and limited
symptom panic attacks - Association with
comorbidity and attack severity
Jan Stender1; Christiane Pané-Farré1; Kristin Fenske1;
Alfons Hamm1
1
Ernst-Moritz-Arndt University of Greifswald, Germany
Introduction: Intense feelings of fear (fear of dying or
fear of going crazy/losing control) often characterize panic
attacks (PA). However, in some cases these cognitive panic
symptoms happen to be missing. According to Beitman et
al. (1987) these attacks are considered “non-fearful panic”
and regarded to be a frequently occurring phenomenon in
persons experiencing PAs. Interestingly, evidence exists
that especially PAs accompanied by fearful cognitions
exhibit higher symptom severity and occur in the context
of higher comorbidity rates as well as more pronounced
avoidance behaviour (Chen et al., 2006; Wilson et al.,
1996).
Objectives and Methodology: The current work
investigated the role of fearfulness during the first fullblown PA, limited symptom attack, or fearful spell and
its association to symptom severity, comorbidity, and
avoidance from an epidemiological perspective (Study of
health in pomerania (SHIP), Völzke et al., 2011).
Results: In our sample (N=318) fearful attacks or spells
were accompanied by higher life time comorbidity as
well as more psychopathology preceding the first attack.
Besides that, higher symptom severity (in each attack
group) was observable if subjects experienced fear
during their attack. Taking into account the severity of the
subject`s fearful cognitions during the first PA it became
evident that highest fear intensity was associated with
higher multimorbidity and avoidance even if compared to
fearful cognitions of moderate strength.
Discussion: Our results support and extent previous
findings showing that fear during the first episode of intense
discomfort is associated with higher psychopathological
burden and greater attack severity.
Conclusion: Thus, considering fearfulness during first
episodes of intense fear or discomfort might be crucial
for the understanding of possible psychopathological
mechanisms in the aetiology of severe psychopathology
as e. g. panic disorder.
Paper Session 7 - Treatment for ADHD /
Treatment for elderly people
Papers
PA 06-05
PA 07-03
Papers
7
Dialectical Behaviour Therapy –based skills
training in group for adults with ADHD
Tatja Hirvikoski1
1
Karolinska Institutet, Stockholm, Sweden
Objectives: The aim of the studies was to evaluate
feasibility, efficacy and acceptability of a Dialectical
Behavioural Therapy (DBT) -based method for adults with
ADHD (Hesslinger, Philipsen, & Richter, 2004; Hesslinger,
et al., 2002; Philipsen, et al., 2007) in a Swedish outpatient
psychiatric context as well as for adults with ADHD and
substance abuse in compulsory care.
Methods: In study one, participants were randomized to
a structured skills training program (n = 26) or a loosely
structured discussion group (n = 24). Feasibility was
estimated on the basis of (1) proportion of individuals
with ADHD considered to be potential candidates for
the treatment; (2) treatment completion; and (3) session
attendance. Treatment acceptability and efficacy were
assessed using self-rating scales. Studies two and
three are on-going uncontrolled effectiveness studies
in open trial design using same treatment manual and
outcome measures as study one. Study two is performed
in a psychiatric outpatient context (at the moment n=70
included participants), while study three is performed in
compulsory care for adults with ADHD and substance
abuse and the treatment is modified to this group (at the
moment n=3 included groups).
Results: In study one, feasibility and participant
satisfaction were good in both groups while skills training
was perceived as more logical and effective for ADHDrelated problems. The per protocol analyses (individuals
stable on medication status n = 19 in skills training; n
= 18 in control group) showed a significant reduction
in ADHD symptoms in the skills training group, but not
in the control group. Study two and three are on-going,
and preliminary results show promising effectiveness in
psychiatric outpatient context as well as for adults with
ADHD and substance abuse in compulsory care.
Conclusions: Group-therapy based on DBT can be a feasible,
effective and well tolerated treatment of ADHD in adults.
188
PA 07-04
Mindfulness-Based-Cognitive-Approach for
Seniors: An eight-month program to expand
mindfulness in ageing
Brigitte Zellner Keller1
1
Université de Lausanne, Switzerland
Thich Nhat Hanh (1996) and Jon Kabat-Zinn (1990,
1994) have brilliantly pointed the way. If one is rather
healthy, there is virtually no age limitation to deciding to
develop one’s mindfulness, and to find energy to mobilize
one’s inner resources.
Based on the well-known MBSR, MBCT and MBRP
programs, the “Mindfulness Based Cognitive Approach
for Seniors” has been developed in the frame of selfdevelopment for seniors wishing to enhance a certain
quality of connection with themselves: a mindful
deliberated and opened way, which spreads moment
after moment. Since there was no clinical motivation to
propose this program in an intensive way - i.e., in eight
weeks, the training lasts eight months (three hours per
month). At first glance, long time intervals between two
sessions might seem uncomfortable for instructors who
are most often used to provide this type of training in an
intensive way in a medical context. It may challenge their
ability to let go the process and to truly be confident into
the resources that healthy participants are proud to (re-)
discover and activate. In our view, in this type of training,
letting time do its work allows the contribution of each
partner to balance out.
At the date of the congress, four groups will have completed
the MBCAS (40 participants ranging from 48 to 81 years).
Motivations, methodology, initial promising results,
discussion about the temporal design of this program and
the specificity of this program oriented towards seniors are
developed.
Engaging seniors in the mindfulness approach appears to
be a relevant objective at a period of life fertile in need to
integrative and instrumental reminiscences, as underline
by Cappeliez et al. (2008, 2009). Moreover, providing
mindfulness training over an eight-month period may be a
very realistic and efficient training for rather healthy people.
Concrete perspectives resulting from this experience are
evoked.
EABCT 2012
Saturday September 1
of self-esteem and self-efficacy, as well as elevated
general psychological distress levels when compared with
the control group. The authors found some, but not all,
of the resources of adults with ADHD to be reduced. In
other words, people with ADHD seem to possess specific
resources (e.g. family, ability to love, courage and faith).
Our results have important implications for the treatment
of adult ADHD and suggest that specific therapy programs
should include modules for enhancing self-esteem, selfefficacy, and fostering resources.
PA 08-01
Association between self-image and self-focused
attention
Yasemin Meral1; Noortje Vriends1
1
University of Basel, Switzerland
Hirsch et al. (2003) found that a negative self-image
plays a causal role in maintaining social anxiety disorder
(SAD). According to Clark and Wells (1995), heightened
self-focused attention (SFA) increases social anxiety
and is also considered to be an important factor in the
perpetuation of SAD. Although, a negative self-image
and SFA proved to play an important role in causing and
maintaining social anxiety, to our knowledge no study has
examined both processes within the same paradigm. This
might be relevant, as the actual self-image might influence
attention processes. The present experiment investigated
the association between a manipulated actual positive vs.
negative self-image and SFA during a real social situation
for the first time. Analyses are controlled for social anxiety.
45 participants (28 female, age 18-25) with either a negative
or positive manipulated self-image (according to Hirsch et
al., 2003) participated in a video-chat conversation with
an instructed confederate. During the conversation, the
participant observed the video image of the confederate
and the same-sized image of themselves displayed on
their computer screen. The conversation was divided into
three phases: 1. introductory phase; 2. flirting phase; and
3. social stress phase. SFA was measured directly by eye
tracking and operationalized as gaze duration participants
observed their own video image relative to the gaze duration
participants observed the video of the confederate. Results
will be presented and discussed in the light of existing
cognitive models of social anxiety disorder.
PA 08-02
Understanding the nature of attention biases to
emotional information
Anna Pavlina Charalambous1; Elaine Fox1; Silke
Paulmann1
1
University of Essex, United Kingdom
Introduction: Research suggests that affective stimuli
(negative & positive) are attended more than neutral
by healthy viewers (Hyona and Calvo, 2006) and that
high trait anxious individuals attend to affective stimuli
but later avoid the negative. (Calvo and Avero, 2005).
EABCT 2012
189
8
Ageing Wisely: Randomised Control Trial of CBT
group treatment for older adults with comorbid
anxiety and low mood
Viviana Wuthrich1; Ronald Rapee1
1
Macquarie University, Sydney, Australia
Introduction: Despite the ageing of the population,
research on the best treatment for anxiety and depression
in older adults is still under developed. We present the
outcome of a randomised control trial of group cognitive
behaviour therapy (CBT) for older adults with comorbid
anxiety and depression compared to a wait list condition.
Method: Fifty-two participants aged 60-84 (mean age
=68.19, SD=6.12, 18= male, 34 = female) with clinical
diagnoses of both anxiety and depression were randomly
allocated to group CBT or a 12 week wait period.
Participants were excluded if they experienced bipolar
disorder, psychosis, substance abuse, or were a suicide
risk. Participants completed structured clinical interviews
and symptom measures are pre-assessment and then
recompleted these measures at post-assessment at a
three-month follow up.
Results: Results indicate that controlling for precognitive status participants in the CBT condition had
significant improvement in both anxiety and depression
for both the clinician rated measures and self-report
questionnaires compared to wait list. Further these
improvements were maintained at the three month follow
up period. Conclusion: These results are the first to
demonstrate the effectiveness of treating comorbid anxiety
and depression in older adults using group CBT. There
will also be discussion of our new NH&MRC randomised
control trial comparing the effectiveness of CBT versus
discussion group for comorbid anxiety and depression in
older adults. Preliminary results will also be presented for
this second randomised controlled trial.
Paper Session 8 - Basic processes:
The role of memory or attention in
psychopathology
Papers
PA 07-05
PA 08-03
The Effects of In Vitro Exposure by Field vs.
Observer Perspectives in the Reduction of Test
Anxiety
A. Kadir Ozer1; Ekin Eremsoy1; Emel Kromer1
1
Dogus University, Istanbul, Turkey
The effects perspective shift in imagery on emotional
experiences has received considerable attention during
past few decades. Although exposure based on imagery in
the treatment of anxiety is a frequently employed mode of
treatment, relative effectiveness of exposure through “field”
and “observer” perspectives has not been explored. Thirty
four high test anxious subjects were randomly assigned to
three experimental groups which were defined as, (1) in
vitro exposure by field perspective, (2) in vitro exposure
by observer perspective, and (3) in vitro exposure without
perspective specification. Each group received six exposure
applications. It was hypothesized that exposure conducted
by field perspective would be significantly more effective
190
in the reduction of test anxiety as compared to the other
applications. One notable result was that 32 subject out of
34 initiated imagery by field perspective. Furthermore, the
results did not confirm the hypothesis. On the contrary,
test anxiety as measured by self report, heart rate and task
performance was significantly reduced in the group which
was exposed by observer perspective. It was noted that
being high on anxiety seems to be highly correlated with
being a “fielder”. Field perspective is defined as imagining
the test situation through the “eye’s point of view” and thus
having an impact in alleviating the emotional experience.
Therefore exposure in principle would be more effective
if conducted in the field perspective. The results clearly
indicate that the reverse seems to hold up. That is, shifting
the subject to an observer perspective and repeating this
“imaginal restructuring” appear to be more effective in the
reduction of test anxiety.
PA 08-04
A theoretical exploration of memory processes
following rape or sexual assault and the
provision of brief psychological therapy for
vulnerable witnesses awaiting criminal trial
Julie Dorey1
1
Cardiff University, United Kingdom
This pre-proposal stage thesis aims to look at the existing
provision of therapy for adult witnesses prior to a criminal
trial as set out by the Home Office, Crown Prosecution
Service, Department of Health and Welsh Assembly
Government. The study will examine the political,
psychosocial and legal implications that impact on the
witness. The aim of this research is to systematically
review the literature in relation to memory processes
following trauma and in the formation of ‘false memories’.
An evaluation of the existing provision of short term
psycholical intervention will be completed. The study
will focus on barriers to engaging with psychological
support and on attrition rates from the Criminal Justice
System. The study will be informed by the Medical
Research Council’s pre-clinical and phase 1 framework for
developing and evaluating complex interventions (Craig et
al, 2008). Mixed methods research applying a sequential
transformative design will be beneficial in conducting
this research. Methods will include a systematic review,
statistical analysis of service outcome measures and
qualitative data in attempting to identify the barriers to
therapy and Criminal Justice System.
EABCT 2012
Saturday September 1
Papers
8
Understanding the exact nature of attentional biases to
affective information can be useful for the treatment or
prevention of anxiety disorders.
Objectives: Is the attention of viewers captured by
affective information? Are any biases characterized by early
engagement, impaired disengagement or avoidance? Are
these biases modulated by trait anxiety? Does presentation
time or repetition of stimuli affect attentional patterns?
Method: Trials were presented for 6000ms in Experiment
1 and for 12000ms in Experiment 2, all trials included four
pictures (2 affective and 2 neutral). Experiment 3 included
Block 1, which was identical to Experiment 1 and Block
2, which contained only pairs of pictures (all trials were
presented for 6000ms).
Results: Experiment 1 indicates that all viewers prefer to
attend to affective information at early stages and later only
to negative information (trait-anxiety differences were not
revealed). Experiment 2 demonstrates that only the high
trait anxious display sustained processing of negative
information. Finally, Experiment 3 shows that higher
stimuli repetition leads to weaker attentional biases to
negative information.
Discussion and Conclusion: Affective stimuli are
attended more than neutral (by all viewers) supporting
the findings of Hyona and Calvo (2006). Additionally,
increased presentation time leads to a strong late bias to
negativity displayed only by the high trait anxious (this
bias is of different nature to the one proposed by Calvo and
Avero (2005)). Moreover, all viewers attend less to negative
information when stimuli repetition is increased. Further
research should investigate how repetition interacts with
trait anxiety
EABCT 2012
PA 09-01
The Effectiveness of an assertiveness Training
Program for bulimia nervosa in an outpatient
treatment setting
Laura Tieghi1 ; Marialuisa Rausa1 ; Anna Franco1 ;
Romana Schumann1
1
Centro GRUBER, Bologna, Italy
Objective: Impairment in interpersonal relationships and
social insecurity, as well as low self-esteem are issues
to treat in Bulimia Nervosa (BN). A structured group
treatment like the Assertiveness Training Program can
add effectiveness and shorten treatment in outpatient
interdisciplinary treatment for BN.
Method: 30 outpatient females with Bulimia Nervosa
(DSM IV R) with low self-esteem and social insecurity
(EDI-II, Insecurity Questionnaire U-FB Ullrich & de Myunck
1998, PWB) followed a 20 week structured Assertiveness
Training Program (ATP) after a initial treatment of 4 CBT
+ 4 Psychonutritional Rehabilitation (PNR) assessment
sessions and 12 CBT + 12 RPN individual interdisciplinary
treatment sessions. The control group of 30 females with
BN had the same initial treatment and continued with 20
CBT + 20 PNR individual treatment sessions, being on the
waiting list for the ATP.
Results: Significant change emerged on measures of
the social insecurity dimensions, low self-esteem and
psychological well being as well as in the eating pathology
symptoms.
Discussion: Preliminary results support the inclusion
of a structured Assertiveness Training Program in the
treatment plan especially in BN with high levels of social
insecurity and markly low self-esteem.
References: Ballardini D., Schumann R. (2011). Riabilitazione
Psiconutrizionale in disturbi alimentari. Carocci, Roma.
Garner D. M. (1991). EDI-2: Professional Manual. Odessa,
Psychological Assessment Resources, FL
Ryff C. D., Keyes C.L. (1995). The structure of Psychological WellBeing Revisited. J Pers Soc Psychol, 69 (4), 719-729.
Ullrich R., de Muynck R. (1998). Testmappe. U-Fragebogen. Pfeiffer,
Muenchen.
191
9
Comparing expressive and positive writing: A
diary study
Nils Toepfer1; Gabriele Wilz1; Anne Katrin Risch1
1
University of Jena, Germany
Introduction: The last decade has seen a shift in research
on writing paradigms away from solely involving writing
about traumatic and negative emotional experiences
toward examining the benefits of writing about positive
events. Only few studies have included both a positive
writing condition (PWC) and expressive writing condition
(EWC), leaving similarities and differences between the
two paradigms rather unexplored.
Objective and Methodology: The purpose of the present
investigation was to compare the impact of a classical
EW task and a newly developed PW task on mood and
realization of personal resources. The PW task aimed at
activating positive feelings through remembering positive
experiences and recognizing personal psychological
resources. 84 undergraduate students were randomly
assigned to keeping either an EW or PW diary 3 days a week
for 4 weeks. Before and after each diary entry, participants
rated their mood on a visual analogue scale. Before the
first and after the last diary entry, as well as 6 months
after participation, participants completed a questionnaire
assessing their current realization of personal resources
(RES, Troesken, 2002).
Results: Repeated-measures ANOVAs with the withinsubject factor ‘measurement’ (pretest-posttest) and the
between-subject factor ‘diary’ (EW vs. PW) revealed
significant interactions between diary and mood as well
as diary and the RES-subscale ‘subjective well-being’
(SWB). Whereas mood positivity increased significantly in
PWC, it decreased significantly in EWC. Similarly, SWB
increased significantly in PWC and decreased, albeit nonsignificantly, in EWC. The difference between EWC and
PWC regarding SWB remained marginally significant at
follow-up.
Discussion and Conclusion: The results provide
evidence for the benefits of activating personal resources
through positive writing. Implications (e.g. of differences
between PWC and EWC) for future research are discussed.
Paper Session 9 - Treatment for eating
disorders
Papers
PA 08-05
PA 09-03
Effects of a Short-Term Cognitive Intervention
for Appearance Investment on Alleviating Body
Dissatisfaction
Eriko Ambo1; Kaneo Nedate2
1
Graduate School of Human Sciences, Japan; 2Waseda
University, Japan
Introduction: Research to date suggests that
psychological investment in one physical appearance is
one of the possible causal factors of body dissatisfaction.
Literature on intervention studies on body dissatisfaction
showed that cognitive-behavioral interventions had
limited effects on appearance investment, suggesting
that a new cognitive approach may be needed. This study
examined effects of a short-term cognitive intervention
(STCI) promoting compassionate self-understanding of
individual’s tendency to invest in their body on decreasing
body dissatisfaction.
Method: Forty-two healthy young female university
students who scored higher than the average on a scale
of trait body dissatisfaction were randomly assigned to
the STCI group (mean age 19.20 [.86]; mean body mass
index (BMI) 20.79 [2.79]), the non-cognitive intervention
(NCI) group in which participants were asked to talk about
their feelings and thoughts regarding their body (mean
age 19.71 [1.20]; mean BMI 21.02 [2.55]), or the control
group which did not receive any intervention (mean age
20.21 [.98]; mean BMI 19.43 [2.09]). The sample size of
all groups was 14. The experimental procedure lasted for
about 80 minutes in each condition.
Results: Results showed that the STCI group yielded preto post-test decrease in the scores of appearance-related
state negative emotions (F (1, 39) = 29.60, p < .001) and
dissatisfaction with one face (F (1, 39) = 25.64, p < .001),
and increase in state self-esteem (F (1, 39) = 26.13, p <
.001), while the NCI and control groups did not.
Conclusions: The findings highlighted the potentially
important role of promoting compassionate understanding
of the possible factors underlying individual’s tendency to
invest in their physical appearance in alleviating body
dissatisfaction and enhancing self-esteem. Developing
and providing a long-term cognitive intervention based on
this study may be beneficial to body-dissatisfied young
women.
Perfectionism and related psychopathological
characteristics in a large sample of Eating
Disorder outpatients
Carmelo La Mela1; Marzio Maglietta1; Sara Mori1; Stefano
Lucarelli1
1
Cognitive Psychotherapy Clinical Centre, Florence, Italy
Introduction: Perfectionism is an important
psychological factor in the development of Eating
Disorders (ED) (Sassaroli et al, 2011) and it is integrated
into the cognitive theories of their maintenance (Farburm,
2003; Slade 1982). Particularly, the “Concern over
Mistake” (CM) dimension of perfectionism (measured
with the Multidimensional Perfectionism Scale, MPS-F;
Frost et al, 1990) results associated with psychopathology
and maladaptive characteristics. This study explores the
psychopathological characteristics of high perfectionist
subjects in an ED sample.
Method: One-hundred-eighty-one ED outpatients
completed the Structured Clinical Interview for DSM-IV
(SCID-I), the Eating Disorder Examination Questionnaire
(EDE-Q), the Rosenberg Self-Esteem Scale (RSES),
the MPS-F, the Stay-Trait Anxiety Inventory (STAI),
the Beck Depression Inventory (BDI), the Dissociation
Questionnaire (DIS-Q), the Anxiety Control Questionnaire
(ACQ) and the Penn State Worry Questionnaire (PSWQ).
We investigated the differences between ED diagnostic
categories. Furthermore, we explored the characteristics of
the highest perfectionist ED patients, classified on the basis
of the CM score.
Results: Among ED diagnosis, the main differences
we observed were about levels of weight and shape
concern and drive to restraint. High perfectionist subjects,
compared with low perfectionist, shown higher levels of
anxiety, depression, worry, dissociation, control tendency
and lower self-esteem.
Discussion: Perfectionism level differs minimally across
the diagnostic group of AN, BN and BED (BardoneCone, 2007), but high level of perfectionism in ED
patients is related to more severe psychopathology in all
the associated dimensions, showing the possibility to
discriminate a group of more severe patients.
192
References: Bardone-Cone A.M., Wondelich S.A., Frost R.O. (2007).
Perfectionism and eating disorders: Current status and future directions.
Clinical Psychological Review, 27.
EABCT 2012
Saturday September 1
Papers
9
PA 09-02
Eating disorder and childhood trauma - An
integrated treatment model
KariAnne Vrabel1; Kjersti Stenshorne1; Lind Anders1
1
Modum Bad, Research Institute, Norway
Introduction: Studies have found that about 30% of
patients with eating disorder have experienced some sort
of childhood trauma, that childhood trauma is related to
more severe eating disordered symptoms and that child
sexual abuse, together with avoidant personality disorder,
predicted a non-responder course of eating disorder. This
supports the clinical notion that patients with co-morbid
eating disorder and symptoms of childhood trauma are
more difficult to treat. Given the high prevalence, the high
severity and prediction of non-response, it is important to
develop an integrating treatment approach toward patients
with eating disorder and symptoms of childhood trauma.
By now, little is known about optimal treatment for these
patients and implementation of treatment models and
future research in this regard is critical.
Method: A new treatment model will be presented
concerning the treatment of both symptoms of eating
disorders and childhood trauma. This is an integrated
model based on Paul Gilberts Compassion-Focused
Therapy aimed at developing self-compassion, managing
self-directed hostility and developing self-soothing
and Christopher Fairburns Transdiagnostic CognitiveBehavioral Therapy for eating disorders focusing on
the processes that are maintaining the patient’s eating
disordered psychopathology. In this treatment model the
patient complete questionnaires about important outcome
measures each week. This provides an objective method for
measuring the patient’s progress thus reducing confusion
about whether treatment is working or not and is especially
helpful in cases with initially poor results which may be in
danger of treatment failure.
Results and discussion: This presentation will describe
the treatment model, the clinical experiences with it and
the patterns of change throughout the therapy process.
Conclusion: A plea for a concerted effort to treat both
symptoms of eating disorders and childhood trauma and
to monitor this treatment by weekly outcome measures is
made.
Effectiveness of combining cognitive group
therapy with dietary therapy versus dietary
therapy on weight loss in obese women
Hamid Reza Sasanfar1; Farzin Rezaei2; Fereshteh
Mootabi3; Mohammad Hassan Abolhassani4; Gholamreza
Mohammadi Farsani5; Abdolreza Pazouki4
1
University of Kurdistan and Minimally Invasive Surgery
Research Center, Iran; 2Kurdistan University of Medical
University, Iran; 3Shahid Beheshti University, Iran; 4Iran
Minimally Invasive Surgery Research Center, Iran;
5
Tehran University of Medical Science, Iran
Obesity treatment is universally disappointing. Traditional
treatments such as dietary treatment sometimes are not
effective and do not leads to efficient weight loss. The
present study is a randomized controlled trial to compare
the effectiveness of combining cognitive group therapy
with dietary therapy versus dietary therapy on weight
loss in obese women. 16 obese women were randomly
assigned to a combining cognitive therapy with dietary
therapy group (N=8) or dietary therapy group (N=8).
Cognitive group therapy was limited to 20 sessions
and 2 hours once a week. Dietary intervention also was
administrated as usual treatment. Dietary treatment was
carried out every two weeks and 8 sessions. Weight was
measured in both groups of participants at the beginning
and after the treatment. The results showed that at the end
of the trial, weight loss of the intervention group (group of
combining cognitive group therapy with dietary therapy)
were significantly higher than control group (dietary
treatment group) (p≤0/05). The results of this study
suggest that combination of cognitive therapy with dietary
treatment may be superior to dietary treatment alone for
the reduction of weight. Cognitive group therapy might be
an excellent strategy to fight against the global epidemic
of obesity.
EABCT 2012
193
9
PA 09-05
Papers
PA 09-04
PA 10-01
Papers
10
Outcome and process measurement in a private
evidence-based clinical practice in Belgium:
Results and implementation issues
Nele Jacobs1; Jaak Beckers1
1
FARESA evidence-based clinical practice, Belgium
Introduction: In the literature, advices can be found for
the implementation of outcome and process measurement
in practice. More information should be available on the
actual results and the implementation issues that are
encountered.
Objectives and methodology: The aim of the present study
was to evaluate the results and implementation of outcome
and process measurement in a private practice in a sample of
60 patients (mean age of 35.39 years (SD 14.59)). Patients’
general evolution was measured before and at the end of
therapy with the Depression, Anxiety, and Stress Scale 21
(DASS21) and the Acceptance and Action Questionnaire II
(AAQ-II). No exclusion criteria were used and the number of
sessions was registered. Paired-Samples T-tests were used
(significance level á=.01).
Results: The mean score on the stress scale of the DASS21
lowered from 23.33 to 9.27 (t=9.98,p<.01). The mean score on
the anxiety scale decreased from 15.90 to 5.93 (t=6.66,p<.01)
and the mean score on the depression scale changed from
19.90 to 6.33 (t=8.36,p<.01). Psychological flexibility
increased from 39.57 to 52.78 (t=-7.33,p<.01), equalling the
population mean in non-clinical samples. The mean number
of sessions was 6.76 (SD 5.59).
Discussion: The present study shows significant
improvements in the outcome and process measures.
However, it needs to be noted that many patients with
incomplete or missing questionnaires had to be removed
from the original dataset leading to a risk of selection bias.
Implementation issues such as patients lost to follow-up
can be distinguished. Routine outcome measurement was
put forward as a solution to track the patient’s progress in
therapy and prevent drop-out.
Conclusion: Future clinical practice will be evaluated and
optimised using (routine) outcome and process measurement,
giving the patient a central position as a customer of care.
Implementation models for measurement in private/public
facilities are needed to improve actual implementation.
194
PA 10-02
Taming the lion with a big cat: B-CAT (behavioral
counter-avoidance therapy)
Nir Essar1
1
Psagot Institute Tel-Aviv, Israel
A protocol for therapy is a prerequisite for a therapeutic
evidence base. If the protocol is for skilled therapists, it can
commence with a treatment plan. The protocol for readers
of a self-therapy book, most of whom are laymen, has to
include stages preliminary to actual treatment. Frightening
Your Fears Away is a therapeutic protocol which, from the
first chapter, imparts the psycho-educational foundations
of fear and anxiety. It goes on to deal with self-diagnosis,
self-conceptualization, and finally to therapy involving
indirect and direct exposure to avoidances.
The lecture will focus mainly on indirect exposure which
permits people with high, levels of chronic anxiety, such
as OCD, to attain optimal exposure. Full exposure is
achieved through preparatory stages that permit success
even without the intervention of a therapist.
PA 10-03
The patient’s little helper: How family and
friends can help one who treats one’s self
Tammy Essar1; Merav Barkavi-Shani1
1
Psagot Institute Tel-Aviv, Israel
Professionals in the field of cognitive-behavioural therapy
(CBT) make widespread use of non-professional helpers.
Such non-therapists facilitate behavioural activation and
exposure between treatment sessions. In recent decades,
family members have often been happy to perform the role
of helpers, and have done so successfully, even though no
professionally-sanctioned protocols for such work have
been published.
One of the most frustrating things for relatives and close
friends is not knowing how to help someone dear to them.
Until now, guidelines of what to do and what not to do have
simply not existed. Above all, relatives and close friends
have lacked awareness that they can perform a central role
in helping someone dear to them.
EABCT 2012
Saturday September 1
Paper Session 10 - Therapeutic issues:
Private PRACTICE, role of families,
adherence to treatment
PA 10-05
Motivational interviewing approach and
contribution to CBT
Murielle Reiner1
1
Geneva University, Switzerland
Motivational Interviewing and CBT share many
characteristics but they lead to specific goals and issues
that differ. We’ll point out some similarities and differences
between these two approaches and emphasize the
important contribution that MI brings to CBT. The main
issues and the overall spirit of MI will also be outlined.
EABCT 2012
PA 11-01
The effect of dissociation, perfectionism and
self-esteem on shape concern: A study on Eating
Disorder outpatients
Carmelo La Mela1; Marzio Maglietta1; Sara Mori1; Stefano
Lucarelli1
1
Cognitive Psychotherapy Clinical Centre, Florence, Italy
Introduction: Many studies show that shape concerns
characterize Eating Disorders (ED). Fairburn (2003)
describes how self-esteem, clinical perfectionism and
mood intolerance encourage striving to achieve in the
domain of shape. Findings highlight the relationship
between dissociation and ED and evidences indicate
a link between dissociation and the severity of eating
symptomatology (La Mela, 2010). This study focuses on
the effect of dissociation, perfectionism and self-esteem
on shape concern.
Method: One-hundred-fifty-eight ED patients completed
the Structured Clinical Interview for DSM IV (SCID-I),
the Eating Disorder Examination Questionnaire
(EDE-Q), the Rosenberg Self-Esteem Scale (RSES),
the Multidimensional Perfectionism Scale (MPS), the
Stay-Trait Anxiety Inventory (STAI), the Beck Depression
Inventory (BDI), and the Dissociation Questionnaire
(DIS-Q). The shape concern scale of EDE-Q was used to
explore shape domain.
Results: A linear regression analysis was performed
to assess the effect of dissociation, perfectionism and
self-esteem on shape concern (dependent variable). The
analysis was performed entering a set of other independent
variables (BMI, STAI, BDI) related to shape concern in
univariate analysis. Shape concern was predicted by high
levels of dissociation, parental criticism (MPS subscale),
BMI and low self-esteem.
Discussion: This study underlines the effect of
perfectionism and self-esteem on shape concern levels,
regardless of depressive and anxious psychopathology.
Furthermore, our results show the importance of
dissociation on this dimension. Dissociation may serve as
a psychological mechanism against intolerable emotional
states, resulting from failures to meet high standards
(Herman CP, 1998).
References: Fairburn, C. G., Cooper, Z., & Shafran, R. (2003).
Cognitive behaviour therapy for eating disorders: a “transdiagnostic”
theory and treatment. Behaviour Research and Therapy, 41,509-528.
195
11
A Cognitive Intervention to Facilitate Adherence
(Compliance) and Change
Ofra Miron-Lichter1
1
Private practice, Tiv’on, Israël
Self-help books are very popular. In effect, dozens are
published each month, and thousands are bought. Even
though many of these books involve an evidence-based
approach, only a handful have proved effective. One of
the books that proved to be effective is Dr. David D. Burns’
Feeling Good (L. Anderson, G. Lewis, R. Araya, et al. 2005
Floyd M, Rohen N, Shackelford JAM, et al. 2006 ). We
assumed that this book’s success is due, at least partly, to
the motivational introduction to each of its chapters, in which
Dr. Burns applies a cognitive intervention. He disassembles
the readers’ old point of view and proposes an alternative
one.
When we deal with anxiety, the idea of exposure is hard
to take-in. In fact, it goes against any previous tendency
that an anxious reader might have experienced during
his lifetime. When we decided to write Frightening Your
Fears Away, a self-help book for overcoming anxiety,
based mainly on the behavioural therapy method, the
issue of motivation was one of our concerns. To overcome
the natural reluctance to adhere, in addition to extensive
explanations and case examples, we have employed the
Psagot non-Adherence Cognitive Errors (PACE) method to
teach the reader the psychology of resistance and the way
to overcome the stumbling blocks that have obstructed
him.
We will describe how we inserted the PACE elements
between chapters and helped disentangle the intricate
cognitive resistance to change, hopefully allowing the
reader to experiment and master the sometimes anxietyprovoking situations of our protocol for adherence.
Paper Session 11 - Eating Disorders:
psychological particularities
Papers
PA 10-04
PA 11-03
Do variations of symptomatology in eating
disorders reflect underlying genetic variations?
Implications for the psyhological treatment
Kirsti Akkermann1; Anu Aluoja1; Marlen Herik1; Anu Järv1;
Kelli Hiio1; Jüri Parik1; Jaanus Harro1
1
University of Tartu, Estonia
Introduction: Eating disorders (ED) are characterised by
intense fear of weight gain and preoccupation with body
weight and shape, which leads to food restriction, and
other dysfunctional weight control behaviours. In clinical
practice the heterogeneity in symptoms and personality
traits can be observed in these patients. Anorexia nervosa
patients are often described as anxious, obsessive and
perfectionistic as opposed to bulimia nervosa patients
who exhibit impulsive behaviour and emotional instability.
However, the studies have shown that the division by
personality traits is not dependent on ED diagnosis. It
has been suggested that genetic factors may explain trait
based variations which may have significant influence on
the course of the illness and treatment response.
Objective: The aim of the current study was to investigate
whether the ED patients can be characterised along the
continuum of compulsive and impulsive traits and whether
allelic differences in the serotonin transporter gene-linked
polymorphic region (5-HTTLPR) are associated with these
traits.
Method: The study comprised 143 women, of these
90 were ED patients and 53 age matched controls. The
diagnostic assessment was carried out according to DSMIV-TR diagnostic criteria. The blood samples and data
about eating behaviour and attitudes were collected during
the first days of hospitalization, and other psychological
measurements were completed following days.
Results: Patients homozygous for the 5-HTTLPR l-allele
exhibited higher scores in preoccupation with body image
and body weight, and concern over mistakes, independent
of the ED diagnosis.
Conclusions: It could be speculated that homozygosity
for the 5-HTTLPR long allele reflects highly preoccupied
and rigid ED individuals, as short allele increases the risk
for affective instability. These findings suggest that ED
patients would benefit from a treatment approach tailored
to the traits characteristic to the patient.
Co-Occurrence of avoidant personality disorder
and child sexual abuse predicts poor outcome in
long-standing eating disorder
KariAnne Vrabel1; Asle Hoffart1; Øyvind Rø2; Egil
Martinsen3; Jan Rosenvinge4
1
Modum Bad Research Institute, Norway; 2Ullevål
Hospital, Norway; 3Aker University Hospital and
University of Oslo, Norway; 4University of Tromsø,
Norway
Objective: To (1) examine what predicts outcome in
belongings to a sub-group of patients with non-responder
longitudinal profile in an Eatig Disorder sample and (2)
what predicts the course of severity of ED symptoms.
Method: A total of 74 patients with long standing ED and
a mean age of 30 years were assessed at the beginning and
end of in-patient therapy and at 1-, 2- and 5-year followup.
Results: The main finding from this study is that avoidant
PD index and child sexual abuse predict a non-responder
course of ED. Consistent with this finding; we found that
child sexual abuse and avoidant PD index interacts in
predicting high levels on global EDE during a long-term
course.
Conclusion: Treatment strategies for such cases should
be integrative rather than additive. To date, there is no
such empirically supported integrative model. It would be
of great interest to develop a psychotherapy treatment and
then study whether this treatment is effective of ED- and
trauma-related symptoms.
196
Saturday September 1
Papers
11
PA 11-02
EABCT 2012
EABCT 2012
Introduction: Eating disorders are difficult to treat and a
significant proportion of those who manage to normalise
their eating behaviour, and who are therefore considered
to have recovered, continue to feel dissatisfaction with
their body and weight. This persistent dissatisfaction is
associated with a risk of relapse. It therefore becomes
important to design and test treatments that focus upon
reducing body / weight dissatisfaction in patients. Although
there is consesus that attitudes to eating, weight, and
figure needs to be addressed in treatment, interventions
that focus on reducing these specific symptoms is scarse.
Given the fact that a large number of people do not
recover from their eating disorder after therapy and that
many relapse into disordered eating, it is of major clinical
importance to find effective and acceptable interventions
to deal with cognitive and affective difficulties in relation to
body and weight that, in turn, may fuel compulsive eating
behaviour, exercising and weight control.
Objectives : We would like to present a 12 session (3
months) manualised Acceptance and Commitment
Therapy (ACT) treatment for outpatient eating disorder
patients, delivered in group format. The treatment focus
on enhancing self image and body image via increased
body acceptance. The emphasis on acceptance, finding
new ways to interact with the body will be highlighted, and
the systematic way in which behavior change is conducted
and aimed at values will be discussed. The treatment is
based on a published selfhelp book. We aim to describe
the intervention, give practical examples of exercies used
in the group therapy and discuss our experiences of using
this intervention in a clinical setting.
Methodology: The main part of the workshop will
be focused on the practical interventions used in the
treatment.
Results : No results will be presented. Acceptability of
the treatment, the group format, will be focused upon and
discussed.
197
11
How do individuals with body dysmorphic
disorder think about their appearance? – A think
aloud approach
Ines Kollei ; Alexandra Martin1
1
University Hospital of Erlangen, Germany
Theoretical background: Cognitive-behavioural models
consider a disordered body image as a core feature of
body dysmorphic disorder (BDD). However, there is scarce
research on body image in individuals with BDD and
body image variables have primarily been assessed with
questionnaires. The aim of the present study was therefore
to assess cognitive-affective features of a disordered
body image by using a quasi-experimental think aloud
approach.
Methods: 30 individuals with BDD, 30 individuals with
major depression and 30 healthy controls were examined.
Structured diagnostic interviews and questionnaires
(Mini-DIPS, BDDDM, BDD-YBOCS, BDI) were used to
confirm primary diagnoses, assess symptom severity and
comorbid diagnoses. Cognitive-affective features of body
image disturbance were assessed using a think aloud task:
Participants were asked to verbalize their thoughts during
baseline, mirror exposure and follow-up conditions. Data
analysis followed the rules of quantitative content analysis.
Results: Compared with both control groups, individuals
with BDD reported more negative body-related cognitions
throughout all think aloud conditions. Irrespective of the
valence of cognitions they reported more body-related
cognitions during baseline and follow-up but not during
body exposure. Even compared with clinical controls,
individuals with BDD reported higher intensities of disgust,
anxiety and shame before and after mirror exposure.
Discussion: The think aloud measures clearly indicate
a cognitive-affective body image disorder in individuals
with BDD. Compared to both control groups, individuals
with BDD reported more body-related cognitions in
general and also more negative body-related cognitions.
The cognitive-affective over-involvement observed during
follow-up suggests post-event processing. Findings point
out the importance of therapeutic interventions focussing
on negative thinking and emotions not only during but also
following mirror gazing.
PA 11-05
Live with your body! – A manualised act group
therapy to enhance body acceptance
Thomas Parling1; Li Wolf2; Anna Wickberg2
1
Uppsala University, Sweden ; 2Queen Silvias Child &
Adolescent Hospital, Göteborg, Sweden
Papers
PA 11-04
PA 12-01
Papers
12
A pilot study on effectiveness of a CBT Anger
control program with children
Serap Ozer1
1
Dogus University, Istanbul, Turkey
Introduction: There are very few studies of effectiveness
of cognitive treatments with young children in Turkey. A
manualized CBT program for anger control in children has
been proposed and shown to be effective (Nelson, Finch
and Ghee, 2006).
Objectives and Methodology: The purpose of the
present pilot study was to adapt the cognitive behavioral
program developed by Nelson, et al (2006) to Turkish
language and to the culture, and to test the program’s
effectiveness. The treatment manual was translated into
Turkish and the sixteen week program was reduced to
an eight week program. The children participating in the
study were recruited from public schools. Parents and
teachers completed CBCL forms. 30 Children aged 8 to
11, scoring one standard deviation above the mean on
the Aggressiveness scale were selected. They were later
divided randomly into treatment and control groups. 15
children who scored in the normal range on the CBCL
were included as a time control group. At pretesting, in
addition to behavioral ratings on the CBCL by teachers
and parents, the children were asked to complete a DrawA-Person task and to complete the Navoco Anger Scale for
children that has been adapted to Turkish (Sutcu & Aydýn,
2008).The children who were selected for the treatment
group participated in 8 weekly sessions of manual based
cognitive behavioral therapy. The tasks in the treatment
program were; recognizing feelings, thought-feelingbehavior relationship, relaxation and self talk, and problem
solving skills.
Results and discussion: Pretest data has been collected
and scored. The treatment program is in progress, at the
end of the 8 week period post test data collection has
begun. Comparisons of treatment, control and time control
groups will be undertaken. The results will be discussed in
terms of implications regarding cross cultural adaptation
of cognitive behavioral programs in clinical settings.
Possible problems encountered in a cross cultural
adaptation will be discussed.
198
PA 12-02
Cognitive bias modification in pre-adolescent
children: Inducing an interpretation bias affects
self-imagery
Stephanos Vassilopoulos1; Nicholas Moberly2
1
University of Patras, Greece ; 2University of Exeter,
United Kingdom
Information processing models suggest that biased
interpretation and self-imagery are implicated in the
genesis and maintenance of social anxiety. Previous
work has shown that inducing an interpretation bias can
change the valence of self-related imagery in adults.
This study extends previous findings by examining
this possibility in children. The effects of manipulating
interpretations concerning hypothetical social events in
children in either a benign or a negative direction were
tested by having children report on self-imagery generated
during subsequent experience with ambiguous social
situations. Our results showed that children reported more
negatively valenced self-imagery after prior practice in
endorsing negative rather than benign interpretations for
ambiguous events. Importantly, this effect was particularly
pronounced in children with high levels of social anxiety.
These results demonstrate that manipulating interpretive
biases can result in corresponding changes in children¢s
self-imagery and further highlight the importance of future
research on the relation among cognitive biases.
PA 12-03
The friends for life program as indicated
prevention in schools
Anja Rogde1; Krister Fjermestad2; JonBjaastad3
1
Fjell municipality, Norway; 2Frambu, Norway; 3Anxiety
Disorders Research Network, Norway
Objectives and methodology: The aim is to evaluate
the effects of a manual-based CBT group treatment
(Friends for life, Barrett et al., 2001) when applied in a
school-setting for youth identified with mild to moderate
symptoms of anxiety in Western Norway. The sample is
comprised of 80 children who were identified by School
Nurses and a Community Psychologist. The children
were invited to attend 10-week group treatment using the
evidence-based Friends for life-manual. Anxiety (Spence
scale) and depression symptoms (Moods and Feelings
Questionnaire) were assessed pre- and post-treatment,
and at 3-month follow-up. Youth were also assessed with
a screening instrument for behavior problems and peer
problems (The Strengths and Difficulties Questionnaire).
Results: We found a significant reduction in anxiety and
EABCT 2012
Saturday September 1
Paper Session 12 - CBT for children 1
Combining ACT and FAP with Educational
Perspective for kids that needs social
improvements
Roberto Cattivelli1; Nicola Maffini2; Serafino Corti3;
Francesco Fioriti3; Chiara Prampolini1
1
University of Parma, Italy; 2LEAVES, Monticelli Terme,
Italy; 3Fondazione Sospiro, Italy
Contextual behavioral science has applications both with
educational and therapeutic fields, but rarely they are used
together. Students who fail to acquire appropriate social
and emotional skills have a lower probability of completing
school, becoming employed, and becoming well-adjusted
adults. This study describes an ACT intervention, focused
in particular on defusion, present moment and acceptance,
and its effects to promote social and emotional skills to
students with learning difficulties. Three students, 9 to 13
years of age, was selected as participants for the study
attending a Learning Centre twice a week for six months.
All measurements were assessed by direct observations,
and the researchers take data-based decision. Delayed
Multiple Probes designs were used to investigate the
effects of intervention.
EABCT 2012
Ricky and the Spider - a CBT computer game for
children with OCD
Veronika Brezinka1
1
University of Zurich, Switzerland
Introduction: Pediatric OCD is a chronic condition with
lifetime prevalence estimates of 1% to 3%. It is often
associated with severe disruptions of family functioning
and impairment of peer relationships as well as academic
performance. The OCD Expert Consensus Guidelines
for treating childhood OCD recommend CBT as the
first-line treatment of choice for prepubescent children.
However, there is a scarcity of CBT for pediatric OCD in
the community. Moreover, there is a lack of treatment
approaches specifically designed for younger children.
Objectives and Methodology: In order to enhance
dissemination of empirically supported treatments,
the therapeutic video game Ricky and the Spider (www.
rickyandthespider.uzh.ch) was developed for children
between the ages of 6 and 12 who suffer from OCD.
The game is not a self-help game and should be played
under the guidance of a therapist. It offers a child-friendly
metaphor to understand OCD and the CBT treatment
approach by incorporating the following elements:
psycho-education, the cognitive model of OCD, creating
a symptom hierarchy, the use of externalizing techniques
to cope with anxiety and unpleasant feelings, and EX-RPexercises.
Results: The game consists of eight levels. The first four
levels deal with psycho-education, whereas from level
5, the child is encouraged to engage in EX-RP, the socalled courage tasks. Apart from assignments in the game,
homework assignments for each level can be downloaded
from the website. Immediately after its first presentation
in December 2011, therapists applied for a version of the
game.
Discussion and Conclusions: Ricky and the Spider is
a therapeutic tool, but does not replace the therapist. Yet,
children and adolescents with OCD have a heightened
risk for clinically significant psychiatric and psychosocial
problems as adults. Thus, intervening early offers an
important opportunity to prevent the development of longstanding problem behaviours.
199
12
PA 12-04
PA 12-05
Papers
depression symptoms from pre- to post and 3-month
follow-up. Effect sizes were medium for both anxiety and
depression symptoms. However, effects were small for
behavior and peer problems.
Discussion and Conclusion: This trial provides critical
information about the effectiveness of the Friends for
life-program in a school setting when applied to youth
identified as at risk for anxiety and depression. Results
indicate that the program is effective for anxiety and
depression symptoms, but may have smaller effects for
other difficulties. This implies that other interventions may
be needed for non-internalizing symptoms.
Paper Session 13 - Mental imagery:
Assessment and treatment
PA 13-01
Papers
13
Manipulating Future Time Perspective Through
Mental Imagery: The Effects on Mood, Goals and
Attentional Bias
Ineke Demeyer1; Rudi De Raedt1
1
Ghent University, Belgium
Introduction: Socioemotional selectivity theory states
that decreased future time perspective would lead to an
emphasis on present-orientated goals of well-being,
with a positivity bias in information processing . Up to
date, research into this theory has mainly focused on
correlational data. To experimentally investigate the effects
of future time perspective on mood, attentional bias and
personal goals, we manipulated future time perspective
using mental imagery.
Objectives and Methodology: Participants were
undergraduates who were randomly assigned to imagery
with short or long term future. The effect of this manipulation
was tested on affect (PANAS) and attention (Exogenous
Cueing Task) in study 1 (N = 41) and on personal goals
(choice between short term and long term consequences)
in study 2 (N = 40). The effect of the manipulation of future
time perspective was tested using an adapted Scrambled
Sentence Test (SST).
Results: We found significant between group differences
on the SST after manipulation in both studies. In study 1,
the SST was negatively correlated to attentional avoidance
for negative cues. Moreover, there was a general increase
of positive and decrease of negative affect, independent of
groups. In study 2, the group who received the long term
future perspective manipulation made more choices which
entailed avoiding immediate negative consequences.
Discussion and conclusion: These results indicate that
the procedure we developed for inducing different time
perspectives was successful. A limited time perspective
was related to less attentional avoidance for negative
information, and also to less behavioural avoidance of
negative consequences. Further implications for wellbeing will be discussed.
200
PA 13-02
Inducing positive mood when feeling dysphoric:
The use of mental imagery
Maud Grol1; Rudi De Raedt1
1
Ghent University, Belgium
Introduction: Recent evidence shows that the ability
to use positive emotions is related to resilience. This
highlights the need for effective procedures to induce
positive mood in people vulnerable to psychopathology
(e.g. affective disorders) in order to investigate this relation
in vulnerable groups. However, positive mood inductions
in depressed people can aversely influence mood, possibly
through a contrast effect. Research on imagery from a field
perspective shows this procedure has a strong effect on
emotion and it is suggested that taking a field perspective
is less likely to promote evaluative thinking which could
evoke contrast effects. Therefore, using imagery may be
effective in inducing positive mood, even in people in a
dysphoric mood.
Method: Thirty-four dysphoric (BDI M = 20.74) and 34
healthy (BDI M = 2.21) volunteers were randomized to
receive a happy or neutral mood induction (MIP). The MIP
consisted of vividly imagining a happy- or neutral-inducing
autobiographical memory. Positive or neutral music was
played during imagery. Mood was measured with the the
Positive and Negative Affect Scale, the tendency to use
mental imagery was measured with the Spontaneous Use
of Imagery Scale (SUIS), and a 5-point Likert scale was
used to assess the extent to which participants used field
perspective imagery during the MIP.
Results: Results showed no influence of dysphoria on the
effectiveness of the MIP.
Although the dysphoric group reported significantly
lower levels of positive mood before the MIP, the groups
no longer differed in positive mood afterwards. These
results remained significant after controlling for the SUIS
or the extent to which participants managed to use field
perspective imagery during the MIP.
Conclusion: Our MIP, involving imagining a happy
memory from a field perspective, is successful in inducing
positive mood in dysphoric people, up to the extent
where they no longer differ in levels of positive mood as
compared to non-dysphoric people.
EABCT 2012
Vividness of mental imagery and occurrence of
intrusive memories
Nexhmedin Morina1; Eilika Leibold1; Thomas Ehring1
1
University of Amsterdam, The Netherlands
Introduction: Intrusive memories of traumatic events
constitute a core feature of post-traumatic stress disorder.
The current study investigated the extent to which vividness
of general mental imagery prior to an analogue stressor
is positively associated with occurrence of intrusive
memories following such a stressor.
Methodology: Sixty-seven participants were exposed
to video material depicting the aftermath of serious
road traffic accidents. Additionally, participants filled in
questionnaires on mental imagery, affect, peri-traumatic
processing style, and intrusive memories.
Results: Vividness of mental imagery before the analogue
stressor correlated positively with the amount, vividness,
and emotional distress due to intrusions as well as
negative affect shortly after the analogue stressor and on
the subsequently five days. Similar results were also found
for the peri-traumatic processing style. The association
between vividness of pre-stressor mental imagery and
post-event intrusive memories was not mediated by prestressor general imagery use in everyday life or peritraumatic perceptual processing style.
Discussion: The findings indicate that high levels of
vividness of general mental imagery might contribute to
the development of intrusive memories following exposure
to traumatic events.
The use of rescripting imagery in people who
hear voices
Luigi Medoro1,2; Rebecca Ison1; Elizabeth Kuipers1
1
Institute of Psychiatry, London, United Kingdom;
2
Queensland Health, Australia;
Introduction: Imagery rescripting is a treatment designed
to reduce the distress associated with an intrusive image
by working on the meanings and memories associated with
the image. Imagery rescripting has its roots in CBT models
for PTSD, where it has been found to be more effective than
imaginal exposure alone (i.e. Grunert et al., 2003). With
Morrison (2002) finding that intrusive imagery is common
amongst people with psychosis, initial attempts have been
made to apply rescripting imagery to this client group.
While these studies have produced promising results, they
have only been applied to people with delusional beliefs
(i.e. Morrison, 2004; Schultze, 2009). There is therefore
a need to apply rescipting imagery to people who hear
voices.
Objectives and Methodology: The study aimed to
explore an imaginal rescripting intervention (Arntz and
Weertman, 1999) with people who hear voices. In the
study, a single session of imaginal rescripting was used in
a case series of four participants who heard voices.
Results: Results demonstrated that imaginal rescripting
is a viable treatment for people who experience intrusive
images relating to their voices. Reductions in distress,
negative affect and reduced conviction in the beliefs
associated with the imagery were reported at one week
follow-up and maintained for three of the four participants
at one month follow up.
Discussion and Conclusion: The study offers
encouraging preliminary evidence for the use of image
rescripting amongst voice hearers. Conclusions, however,
are limited by the small sample size and an initial case
study design. Future research is needed to further explore
the use and efficacy of imagery work amongst people who
hear voices.
Key points:
• Imaginal rescripting is a viable treatment for people who
experience intrusive images relating to their voices.
• Reductions in distress, negative affect and reduced
conviction in the beliefs associated with the imagery were
reported.
EABCT
2012012
201
13
PA 13-04
Papers
PA 13-03
PA 14 - 01
Papers
14
“Tuning Your Temper”: The Effects of a Brief CBT
Group Intervention for Quick-tempered Children
with different degrees of parental involvement
Urdur Njardvik1; Hronn Smaradottir1
1
University of Iceland, Reykjavik, Iceland
Introduction: Irritable mood is a prominent feature
of most psychiatric disorders diagnosed in childhood
and due to overlap in symptoms, avoidance in anxious
children can be misdiagnosed as oppositional behavior
(Youngstrom, 2007; Schniering et al, 2000). Children with
disruptive behaviors at school may thus benefit from a
transdiagnostic approach.
Objectives and Methodology: The purpose of this
study was to assess the effects of “Tuning Your Temper”
a brief CBT program aimed at increasing problem
solving skills and self-esteem in young, quick-tempered
children. 80 children, aged 7- 11 years, were randomly
assigned to intervention or wait-list control conditions. All
participants had been referred to psychological services
due to behavior problems. The program consisted of six
weekly sessions delivered during school hours. Eight to
ten children participated in each treatment group led by
two therapists. Half the parents had no involvement while
the remaining half received two individual treatment
sessions. Assessment instruments included the SDQ and
the DBRS administered to parents and teachers pre- and
post-treatment and at 6 months follow-up.
Results: A significant decrease in disruptive behaviors in
school was found as measured by the DBRS F(1,62)=10,05
p<.01; and as measured by the Conduct Problems subscale
of the SDQ F(1,62)=5,56 p<.05. Significant differences were
found in teacher ratings between pre-post assessments for
the treatment group on the DBRS t(35)=3,3 p<.01 and the
Conduct Problems subscale of the SDQ t(35)=2,14 p<.05.
For parent ratings, significant differences were found
between pre-post assessment using the DBRS t(34)=2,1
p<.05. Treatment gains were maintained at 6 months
follow-up. No significant differences were found between
the two parental involvement groups.
Discussion and Conclusion: This brief CBT intervention
appears to be both effective and easy to administer within
the school system, as parental involvement seems
redundant.
202
PA 14 – 02
Experimentally modifying interpretations and
emotional judgments for positive and negative
social scenarios in children: A preliminary
investigation
Stephanos Vassilopoulos1; Nicholas Moberly2
1
University of Patras, Greece; 2University of Exeter, United
Kingdom
Past research suggests that socially anxious individuals
display a tendency to interpret ambiguous and clearly
valenced information in a threatening way. Interpretation
training programs, in which individuals are trained to
endorse benign rather than negative interpretations of
ambiguous social scenarios, have proven effective for
reducing anxiety-related cognitive biases. However, it
is not clear whether the same paradigms are effective in
modifying interpretation biases for clearly valenced social
information. In this experiment, a group of unselected
children (aged 10-11 years) was trained to endorse the
more positive of two possible interpretations of mildly
negative and positive social events. Data revealed that
this group (n = 46) showed a decrease in catastrophic
interpretations and an increase in neutral interpretations
of mildly negative events compared to children in
a no-training control group (n = 44). Furthermore,
participants in the training condition showed a trend for
a decrease in anticipated negative emotional reactions
to negative events. Additionally, meditational analyses
showed that reductions in catastrophic interpretations of
mildly negative events mediated the marginal effect of
interpretation training on reductions in negative emotional
reactions to such events. However, no effect of training on
interpretation and judgments regarding positive events or
trait social anxiety was observed. Notwithstanding certain
limitations of this pilot study, we believe that the results
are promising with regard to modifying interpretative and
judgmental biases for clearly valenced vignettes, and that
further study regarding the effects of training on mood is
warranted.
EABCT 2012
Saturday September 1
Paper Session 14 - CBT for Children 2
RETMAN: Teaching children rational thinking
strategies for emotional regulation through
robotherapy
Oana Gavita1; Daniel David1; Bram Van der Borght2
1
Babes-Bolyai University, Cluj-Napoca, Romania; 2Vrije
Universiteit Brussel, Belgium
Positive outcomes have been reported recently in the
literature for the usage of robots (robotherapy) (i.e., Probo,
Keepon) in the therapy of children presenting different
types of psychopathology (Dautenhahn, & Billard, 2002;
Kozima, Nakagawa, & Yasuda, 2005; Vanderborght et al.,
in press). We have applied here the same principles to
build the Retman toy and mechatronic device (Feil-Seifer
& Mataric, 2005), based on the character having his own
story and adventures in a book called “Retmagic and the
wonderful adventures of Retman” (David, 2006). The first
RETMAN concept is inspired by Albert Ellis’ RationalEmotive & Cognitive-Behavior Therapy (REBT/CBT)
and was thought as a cartoon character meant to make
accessible the principles of REBT/CBT among children and
adolescents (Merrifield & Merriefield, 1979) by rational
stories (see Waters, 1980). In this paper we are presenting
preliminary data showing the efficacy of RETMAN concept
versus standard parental training in child emotional
regulation, by using a controlled study design (N=32).
More precisely, the RETMAN robot is embedded within
a RETMAN doll, based on the look of the story characte
r. Thus, the RETMAN has the role to teach children how
to think rationally and change their dysfunctional negative
mood through offering rational reappraisal statements
(«psychological pills»; David, 2007). The applications of
RETMAN as therapeutic tool are discussed in light of its
capacities for informing the therapist on its usage by the
child.
gNATenborough’s Island: A C-CBT adaption for
young people with internalising disorders
Aisling O’ Dwyer O’ Brien1; Gary O’ Reilly1; Sadhbh
Coyle2; David Coyle3,4
1
University College Dublin, Ireland; 2National Educational
Psychological Service, Ireland; 3University of Bristol,
United Kingdom; 4University of Cambridge, United
Kingdom
Introduction: Cognitive Behavioural Therapy (CBT)
is a common intervention for children with internalizing
disorders. However, our understanding of CBT with young
people is still limited. Some children do not respond to
a CBT programme. CBT for children has often followed
adult models which are not developmentally appropriate
or tailored specifically for children.
Objectives: To conduct an Exploratory Randomised
Controlled Trial (RCT) of a developmentally appropriate
Computerised- CBT (C-CBT) game gNATenborough’s
Island, that young people with internalizing disorders play
in session with their therapist.
Methodology: Twenty six participants were considered for
eligibility. Eighteen participants met the inclusion criteria
of being in the clinical range on an internalising disorder
subscale of the Child Behaviour Checklist. Participants
were randomly assigned to either the intervention or
control group. All participants completed the Child
Behaviour Checklist, Teacher Report Form, Youth SelfReport, Culture Free Self-Esteem Inventory, Children’s
Automatic Thought Scale at a time equivalent to pre and
post intervention. The intervention group also completed
the Child Session Rating Scale and the Working Alliance
Inventory after each session. The C-CBT programme was
delivered in a school setting by Educational Psychologists.
Both participants and the Educational Psychologists
completed a feedback form on the C-CBT programme.
Results: A total of 17 participants completed the pre and
post assessments for the RCT. Discussion: The theoretical
and methodological strengths and weaknesses of the study
and implications for future development of game based
technology assisted CBT with children will be discussed.
Conclusions: The results of this research will contribute
to the on-going development of the C-CBT game for young
people with internalizing disorders.
EABCT 2012
203
14
PA 14 - 04
Papers
PA 14 - 03
Risk Taking Behaviour in Children and Adolescents
Talia M. Morris1; Jennifer Hudson1; Helen Dodd2
1
Macquarie University, Sydney, Australia; 2University of
East Anglia, Norwich, United Kingdom
Papers
16
Introduction: The Balloon Analogue Risk Task (BART) is
a behavioural measure of risk taking (Lejuez et al., 2002).
The aim of the present study was to examine whether
children differ in their risk taking behaviour based on the
temperament style behavioural inhibition (BI) and anxiety
symptoms. BI has been associated with withdrawal from
novelty which may be part of a broader aversion to risk (e.g.
Hirshfeld-Becker et al., 2008). This aversion may in turn
place BI children at an increased risk for psychopathology
as they may miss rewarding experiences such as social
interactions.
Method: Two groups of participants were recruited. 68 early
adolescents (aged 11.5-12.5 years) were recruited as part
of a longitudinal study examining the role of behavioural
inhibition in the development of anxiety and depression.
A further 90 preschool aged children (aged 3.5-4.5 years)
were recruited as part of an intervention study. Behavioural
inhibition was assessed using the approach scale of the
Children’s Temperament Questionnaire-short version
(Sanson, Smart, Prior, & Oberklaid, 1994). The presence
of child anxiety disorders was assessed using the Anxiety
Disorders Interview Schedule for Children (Silverman &
Albano, 1996). Anxiety symptoms were assessed using the
Spence Children’s Anxiety Scale (SCAS; Spence, 1997).
Results: Preliminary results showed no significant
difference between the BI and non BI participants with
regards their risk taking on the BART. This was consistent
across age groups. In the early adolescent group, however,
there was some indication of a relationship between
anxiety and risk taking, with higher scores on the SCAS
associated with less risk taking.
Conclusions: The preliminary results suggest that early
adolescents with higher levels of anxiety symptoms
may take fewer risks. The potential implications of these
findings will be discussed with regards to possible social
difficulties due to reduced risk taking and risks for later
psychopathology.
204
Paper Session 16 - Addiction: Basic
processes and treatment
PA 16 – 01
Drinking motives and information processing in
alcohol use disorder patients with and without
social anxiety disorder
Ruth Cooper1; Sibylle Hildebrandt1; Alexander Gerlach1
1
University of Cologne, Germany
The high comorbidity of alcohol use disorders (AUD)
and social anxiety disorder (SAD) is often explained by
excessive drinking in social situations to self-medicate
social anxiety. Indeed, the motive to drink alcohol to lower
social fears was found to be elevated in socially anxious
persons. However, this social anxiety specific motive has
not been directly investigated in alcoholics. We explored
social anxiety, the motivation to drink alcohol in order to
cope with social fears, and social anxiety as a consequence
of drinking in alcoholics with and without comorbid SAD.
AUD inpatients with (AUD+SAD group, N = 23) and without
comorbid SAD (N = 37) completed questionnaires and
underwent an emotional Stroop task with socially relevant
and neutral word stimuli. AUD+SAD patients reported an
elevated motive to drink due to social anxiety but did not
experience more social fears as a consequence of drinking.
Self-reported social anxiety was the best predictor for
biased social threat-related information processing.
The elevated social anxiety related drinking motive in
the AUD+SAD group and the lack of differential effects
for experiencing social anxiety due to drinking suggests
social fears to precede the onset of AUD. Furthermore,
the prevalence of biased social threat-related information
processing highlights the psychopathological impact and
severity of social anxiety in AUD patients. Consequently,
AUD patients may benefit from SAD specific diagnostics
and treatment options.
EABCT 2012
Saturday September 1
PA 14-05
High-risk behaviours and HIV/ HCV positivity
among intravenous stimulant users
Ingunn Hansdottir1
1
University of Iceland, Reykjavik, Iceland
This study examines risk-taking behaviours, including
injection practices and sexual behaviour, and the status
of HIV and HCV prevalence among intravenous (IV) drug
users (IDU). A secondary aim is to identify factors related
to risk-taking behaviours in this population. IV drug users
often have multiple risks of contracting or transmitting
infectious diseases such as HIV, Hepatitis C (HCV) and
Hepatitis B, mainly through the use of contaminated
equipment. Also, amphetamine use has been related to
increased HIV transmission among subgroups. The rise of
IV drug use and stimulant drug use seen in some parts of
the world are thus a public health concern. Because of the
rise of amphetamine use in Iceland and a recent increase
in HIV among stimulant users, a cross-sectional study
is underway to address this health issue. Amphetamine
dependent IV drug users seeking addiction treatment
at Vogur Hospital, are currently being recruited (n=45,
mean age= 33,3, 32 males) and evaluated using the RAB
(Risk Assessment Battery; Metzger, Woody, Druley, 1990)
a self-report measures that assess both drug taking risk
behavbior and sex-related risk behaviors); (2) the ASI
(Addiction Severity Index; McLellan et al., 1992; a semistructured interview assessing problem severity and
consequences of substance use in seven areas: medical,
employment/support, substance use, legal, family/social
relationships and psychiatric problems) (3) and HIV and
HCV biological testing. Data anlaysis will be presented
on demographics of risk behvaiors and seroprevalence.
Preliminary analysis show gender differences in drug-risk
behaviours, (females score significinatly higher (F(1, 29)=
7,5, p<.05) and over one-third of participtants have shared
needles (38,5%) and 17% have shared with those known
to be HIV positive. In order to target prevention, treatment
and care of this often underserved population, data on
IV use, HIV infections and other behavioural factors are
important.
A positive group experience and temporary
smoking abstinence program as part of
psychiatric care
Ineke Keizer1; Patrice Croquette1; Aqal Khan1
1
University Hospitals Geneva, Switzerland
Introduction: A multi-component intervention to enhance
motivation to stop smoking was introduced in a psychiatric
hospital. It consists in a 24-hour tobacco abstinence
period associated with a strong positive group experience
and includes information about smoking, thermal baths,
music and group therapy sessions.
Method: Participants were evaluated some days before
(t1), during (t2) and one week after (t3) the intervention on
tobacco related variables, anxiety, depression, well-being
and global health perception.
Results: Data were analyzed in a preliminary sample
of 26 patients. Participants were 65.4% male, mean
age 37.9 years old (sd 15.1), 44% psychotic disorders,
57.7% heavy smokers and 70.8% in precontemplation
stage. 52% maintained a 10-hour abstinence period and
36% a 24-hour period. Change over time was as follows:
commitment to smoking cessation (Kahler’s scale)
t1=25.7, t2=26.8, t3=28.1, p=.35; state anxiety (STAI)
t1=46.9, t2=40.1, t3=39.3, p=.35; self-reported depression
(BDI) t1=15.1, t2=12.3, t3=11.1, p=.06; well-being (WHO
scale) t1=12.7, t2=15.7, t3=15.5, p=.31; and global health
perception (1-10 scale) t1=6.2, t2=7.2, t3=6.6, p=.06.
Discussion: Small sample size presently limits
interpretation. Data nevertheless suggest improvements
on all variables, which might be related to both the
intervention and the benefits of psychiatric care during
hospitalization. If confirmed, higher results on t2 only
could indicate more specific effects of the intervention,
such as higher well-being and global health perception.
Patients showed very high satisfaction and personal
involvement in the experience. Clinical observation
suggests that this positive state, though temporary, is
noteworthy and could be used in some cases as additional
help within psychiatric care.
Conclusion: Although this intervention aimed at
promoting tobacco cecessation, its benefits on mental
health deserve further evaluation.
EABCT 2012
205
16
PA 16 – 03
Papers
PA 16 – 02
Papers
17
Online games addictions: a cognitive and
motivational approach
Joël Billieux1
1
Catholic University of Louvain-La-Neuve, Belgium
Massively Multiplayer Online Role-Playing Games
(MMORPGs) are video games in which a large number
of players interact with one another in a persistent virtual
world (i.e. a world that exists independently of the players).
In MMORPGs, the player assumes the role of a fictional
character and takes control of many of that’s character actions.
MMORPGs are characterized by an advancement system
implying that the more a person plays the more his or her
character will acquire new skills and powers as rewards.
Another fundamental feature of MMORPGs is that they allow
the participation in different types of social networks (e.g.,
persistent organizations of players with common objectives).
In certain cases, MMORPGs can become problematic and
engender negative outcomes in daily living (e.g., compromised
social and individual quality of life). Problematic MMORPGs
use is associated to a variety of symptoms frequently found
in other behavioral addictions such as pathological gambling
(e.g., lack of control, cravings, compromised time control).
In this talk, I will review some studies we recently conducted
to disentangle the psychological factors involved in
problematic MMORPGs involvement. The presentation
will in particular focus on the role of both self-regulation
capacities and motives for playing online (e.g., immersion,
achievement, or social motives). Data emphasizing the
existence of distinct profiles of problematic online gamers
will also be presented. Finally, I will claim that online
games addictions should be integrated into a spectrum of
cyber addictions, encompassing a variety of dysfunctional
behaviors related to involvement in specific online activities.
PA 16 – 05
Cognitive-behavioral treatment of kinetic
disorder and addiction to substances
Christine Davidson1; Philippe Maso1
1
MD Consultation, Geneva, Switzerland
The Hyperkinetic disorder is a problem frequently
encountered in adults with a substance dependency
syndrome.In the patient population of MD Consultation,
a specialised institution in the treatment of addiction with
or without substances, a specific program of cognitive
behavioral treatment to hyperkinetic disorder has been
established for patient presenting this dual diagnosis. Details
of therapeutic strategies used, their use and the evaluation of
the results will be the subject of this presentation.
206
Paper Session 17 - Psychosis: Basic
processes and treatment
PA 17-01
Intrusive imagery in people who hear voices: A
cross sectional study
Luigi Medoro1,2; Rebecca Ison1; Elizabeth Kuipers1
1
Institute of Psychiatry, London, United Kingdom;
2Queensland Health, Australia
Introduction: Psychological models of hearing voices
(Morrison, 1995; Garety et al., 2001) propose that the cognitive
appraisals of voices or auditory verbal hallucinations are
central in maintaining the affective, behavioural and somatic
responses of voice hearers. Morrison (2002) found intrusive
imagery to be common amongst people with psychosis
and proposed that imagery may help maintain psychotic
symptoms indirectly by maintaining appraisals about the
voices and associated affective responses. There is a need
for research to investigate this relationship between intrusive
imagery and hearing voices.
Objectives and Methodology: The study aimed to
explore the extent to which people who hear voices
experience intrusive images and, if they do, the affective and
cognitive characteristics of those images. In the study, 40
participants who were currently hearing voices completed
a semi-structured interview assessing the characteristics of
intrusive imagery.
Results: 75% (n=30) of participants reported experiencing
intrusive imagery, and 55%(n=22) reported experiencing
imagery relating to their voices. Distressing imagery was
positively correlated with severity of the voices, higher
levels of depression, stress and negative core beliefs
about the self.
Discussion and Conclusion: The study supports the
hypothesis that intrusive imagery is common amongst
people who hear voices. It also indicates that intrusive
imagery may be a contributory factor in the maintenance
of voices, symptoms of depression and stress and beliefs
about the self. Future research is needed to assess the
potential role of intrusive images in hearing voices.
Key points:
• A significant proportion of participants who hear voices
reported experiencing intrusive imagery and reported
experiencing imagery relating to their voices.
• Distressing imagery was positively correlated with
severity of the voices, higher levels of depression, stress
and negative core beliefs about the self.
EABCT 2012
Saturday September 1
PA 16 – 04
Rumination in schizophrenia: mediation between
awareness of illness and depressive symptoms
Neil Thomas1; Darryl Ribaux2; Lisa Phillips2
1
Swinburne University, Melbourne, Australia; 2University
of Melbourne, Australia
Introduction: In schizophrenia, depressive symptoms
frequently emerge following recovery from acute
psychosis. Such depressive symptoms have been observed
to be predicted by level of awareness of illness. This is
an association likely contributed to by other cognitive
processes. One of the most well-established cognitive
processes associated with depression is rumination, a
pattern of perseverative, self-focused negative thinking.
Objectives and Methodology: This study aimed to
determine whether rumination focused on mental illness
was predictive of depressive symptoms during the subacute
phase of schizophrenia, and whether it has a mediating
role in the observed association between awareness of
illness and depressive symptoms. Forty participants with a
diagnosis of schizophrenia and in a stable phase of illness
completed measures of rumination, depressive symptoms,
awareness of illness, and positive and negative symptoms.
Results: Depressive symptoms were correlated with
rumination, including when controlling for positive
and negative symptoms. The content of rumination
frequently focused on mental illness and its causes
and consequences, in particular social disability and
disadvantage. Depressive symptoms were predicted by
awareness of the social consequences of mental illness,
an effect which was mediated by rumination as predicted.
Discussion and Conclusion: Results suggest that a
process of perseveratively dwelling upon mental illness
and its social consequences may be a factor contributing
to depressive symptoms in people with chronic
schizophrenia.
Spiritual Group Therapy for patients with
Psychosis
Sylvia Mohr1
1
Geneva University Hospitals, Switzerland
Introduction: Spirituality and religiousness (S/R) are
resources for coping with symptoms, finding meaning and
hope in suffering and key components of psychological
recovery. However, S/R may also be associated with
psycho-pathology, suffering and non-adherence with
treatment. The integration of S/R into care ranges from
referral to chaplain, exploration of spirituality in individual
and group psychotherapies, bringing in spiritual concepts
and practices into psychotherapies, to holistic care
programs.
Objectives: Examination on integration of S/R in CBT
group therapy.
Methodology: Implementation of an inter-faith pilot
“Spirituality and Recovery Group”, designed according
to literature on spiritual groups and research findings on
spirituality and psychosis.
Results: Themes addressed in the group concern
the confusion between S/R and psychotic symptoms;
discerning the spiritual meaning of the illness;
understanding the interrelations between spiritual history
and mental illness; identifying helpful and harmful
forms of S/R coping; addressing supportive vs. harmful
relationships with religious community members and
religious professionals; considering the relationships
between S/R and self-identity; dealing with stigmatization
due to S/R and mental illness; articulating representations
and emotional relationships with God and other spiritual
figures; and identifying existential issues about the
meaning of life and death, sexuality, suffering, theodicy,
forgiveness, sin and guilt.
Discussion: Delusions and hallucinations with religious
content deserve special attention. Treating them as they
are, i.e. symptoms, allows both avoiding the stigmatization
of the S/R dimension in a patient’s live and providing
effective cognitive therapy for those symptoms.
Conclusion: Integrating S/R has to consider the cultural
context of the psychiatric service, the characteristics of
S/R of the patient as well as pathological specificities. It
doesn’t increase psychopatholoy.
EABCT 2012
207
17
PA 17-03
Papers
PA 17-02
PA 18-01
Papers
18
The Interplay between Expressed Parental
Anxiety and Infant Behavioural Inhibition
Predicts Infant Avoidance in a Social
Referencing Paradigm
Evin Aktar1; Mirjana Majdandži1; Wieke De Wente1; Susan
Bögels1
1
University of Amsterdam, The Netherlands
Background: Anxiety aggregates in families.
Environmental factors such as modelling of anxious
behaviours are assumed to play a causal role in the
development of child anxiety. We investigated the
predictive value of paternal and maternal anxiety (lifetime
anxiety disorders and expressed parental anxiety) on
infants’ fear and avoidance during encounters with social
and non-social novel stimuli in a social referencing (SR)
paradigm.
Objectives and Methodology: 122 12-month old
infants participated in this study separately with their
fathers and mothers (parents with lifetime: social anxiety
disorders (n=47), other types of anxiety disorders (n=33),
comorbid social and other types of anxiety disorders
(n=52), and without anxiety disorders (n=112)). Infants
were confronted with a stranger and a mechanical dinosaur
as novel stimuli in two SR situations. Infants’ avoidance as
well as fear and parents’ expressed anxiety were observed.
Infants’ behavioural inhibition (BI) was separately observed
in structured tasks.
Results: Expressed parental anxiety interacted with BI to
significantly predict infant avoidance, revealing a positive
association between expressed parental anxiety and infant
avoidance among infants with moderate to high BI. The
association between infant avoidance and expressed
parental anxiety was not significantly different for mothers
and fathers at this young age. Surprisingly, parental
lifetime anxiety disorders did not significantly predict
infants’ fear or avoidance.
Discussion and Conclusion: Infants with a
temperamental disposition for anxiety (BI) may learn from
both paternal and maternal anxious signals and become
avoidant towards novelty when their parents express
anxiety. This link between expressed parental anxiety and
infant avoidance for moderate and high BI children, that
seems to hold across contexts and to be independent of
lifetime parental anxiety disorder, may be a mechanism
explaining intergenerational transmission of anxiety.
208
PA 18-02
Dimensional assessment of anxiety disorders in
parents and children in the DSM-5
Eline Möller1; Mirjana Majdandži1; Michelle Craske2;
Susan Bögels1
1
University of Amsterdam, The Netherlands; 2University of
California, Los Angeles, United States
Introduction: After decades of a categorical approach to
psychiatric disorders, the DSM is now shifting towards
including a dimensional component to the categorical
approach. This inclusion of dimensional information
allows clinicians and researchers to demonstrate not
only the presence or absence of psychopathology in an
individual, but also the degree to which the disorder and
its symptoms are manifested.
Objectives and methodology: This study evaluated
the psychometric properties and utility of a set of brief
dimensional scales that are consistent in content and
structure and assess core features of anxiety disorders,
in children and adults. The dimensional scales and the
SCARED-71 (child and adult version), a questionnaire
to assess symptoms of all anxiety disorders in children
and adults, were administered to a non-clinical sample
of children (n=382), aged 8-13 years, and their mothers
(n=285) and fathers (n=255). The dimensional scales
assess six anxiety disorders: Separation Anxiety Disorder,
Panic Disorder, Agoraphobia, Specific Phobia, Social
Anxiety Disorder, and Generalized Anxiety Disorder.
Children rated their own anxiety and parents both their
own and their child’s anxiety.
Results: The dimensional scales demonstrated high
internal consistency and moderate to high levels of
convergent validity. The discriminant validity of the
dimensional scales was slightly lower than the discriminant
validity of the SCARED. Father-mother agreement on their
child’s anxiety was higher than parent-child agreement.
Children reported higher levels of symptoms on all
subscales compared to parents reporting child anxiety.
Discussion and conclusion: Although more research
on the dimensional scales is needed, especially with
clinically anxious parents and children, addition of the
dimensional scales to the DSM-5 might be an effective
way to incorporate dimensional measurement into the
categorical DSM-5 diagnosis of anxiety disorders.
EABCT 2012
Saturday September 1
Paper Session 18 - relationship between
children and parent anxiety
Income level and the relationship between
parental intrusiveness and the developmental
trajectory of anxiety in childhood
Christine Cooper-Vince1; Candice Chow1; Donna Pincus1;
Jonathan Comer1
1
Boston University, USA
Anxiety disorders are among the most common
psychological disorders in childhood, with lifetime
prevalence estimates of 31.9% by adolescence
(Merikangas, et al., 2010). Intrusive parenting is positively
associated with child anxiety (Wood, et al., 2003), however,
this relationship has primarily been studied in middle to
upper middle class families (Bayer et al., 2006; Hudson &
Rapee, 2002). In low-income families, maternal monitoring
is negatively associated with child anxiety (Buckner et al.,
2003) and the relationship between poverty and child
internalizing problems is partially mediated by parental
hostility and lack of parental support and involvement
(Grant et al., 2003). As current interventions for child
anxiety emphasize reducing parental intrusiveness (Comer
et al., 2012; Pincus et al., 2011), it is essential to determine
whether the current findings on parental intrusiveness
generalize to low-income families.
This study employed latent growth curve analysis to
evaluate the interactive effects of parental intrusiveness and
income related variables on the developmental trajectory
of child anxiety in 1,121 children (49.9% male) and their
parents from the NICHD SECCYD. We hypothesized that
greater parental intrusiveness would be associated with
increasing child anxiety among children of higher income
and those living in safer neighborhoods, but not among
low income children and those living in more dangerous
neighborhoods. Child anxiety was measured with the
CBCL Anxiety Problems Scale (Achenbach, 1991) in
1st, 3rd, 4th, 5th, 6th and 9th grades; means are 1.23,
1.24, 1.12, 1.22, 1.14, and 0.81, respectively. Parental
intrusiveness was measured through observational ratings
of a structured play task. The model was found to provide
good overall fit (x2=42.336, p=0.004, SRMR=0.020),
parsimony (RMSEA=0.003), and good fit of the specified
model to the null model (CFI=0.992, TLI=0.988). The
strength and interpretability of parameter estimates will be
discussed.
Social anxiety in its context - cultural
comparison of father’s and mother’s role in the
development of social anxiety
Noortje Vriends1; Susan Bögels1; Lynn Alden2; Nina
Heinrichs3; Stefan Hofmann4; Ron Rapee5
1
Amsterdam University, The Netherlands; 2British
Columbia University, Canada; 3Bielefeld University,
Germany; 4Boston University, USA; 5Macquarie
University, Sydney, Australia
Lifetime prevalence rates of social anxiety disorder (SAD)
range between 5% and 13% depending on the cultural
background of the particular sample. This remarkable broad
range of prevalence rates of SAD suggests that context
variables play a major role in the development of SAD.
Though so far context variables, especially cultural and
parental variables, have not gained much of attention in the
etiology of SAD.
In this round table we present a study that we plan to
conduct across 10 cultures, in which we will investigate
cultural differences in father’s versus mother’s role in the
development of high levels of social anxiety in students. After
the presentation of our planned study, we invite participants
of the round table to discuss with us about our project. The
following questions will guide our discussion: Why do
SAD prevalence rates range across cultural backgrounds?
Which cultural and parental factors might be relevant for the
pathway of humankind social anxiety to a clinically relevant
SAD? How might cultural background and parental style or
parental behavior interact? What might be the different role
of father and mothers across cultures? Which cultures might
represent cultural diversity in parental styles?
We aim to integrate the discussion outputs in our planned
study. New collaborations are also welcome.
EABCT 2012
209
18
PA 18-04
Papers
PA 18-03
PA 19-01
Papers
19
Therapeutic competencies in CBT - Conception
and measurement
Anton Rupert Laireiter1; Barbara Pilgerstorfer1
1
University of Salzburg, Austria;
Aims: Outcome in psychotherapy is explained only to
a small amount by specific methods and techniques.
Additional factors, such as the quality of the therapeutic
relationship, certain features of the therapist and the client
as well as more general, so called common working factors
are of relevancy too. As a consequence, psychotherapists
are not only are to be trained in theories and methods of
a certain psychotherapeutic orientation; they also have
to develop additional therapeutic competencies. Within
CBT only a few models and considerations exist, which
competencies this should be, in addition there are just
very few measures to assess them.
Methods: To fill this gap a model of therapeutic
competencies in CBT as well as self-rating- and rating-byothers-scales (supervisor, client/patient) to measure them
were developed by the authors. The planned contribution
primarily deals with the model and self-rating-scale
(“Inventory of Therapeutic Competencies in CBT, ITCCBT). The rating-by-others-scales are under construction
at the moment.
Results: The model represents six areas of CBTcompetencies: Theoretical and methodological knowledge
about CBT, personal, interpersonal, techniques-related and
ethical competencies, as well as CBT-identity. Scale- as well
as components-analyses of the ITC-CBT integrating data
from 238 CB-therapists and therapist in training in CBT
affirmed its internal validity and its reliability. In addition
support was found for its differential and construct validity
(length of training, accredited therapists vs. therapists in
training, correlation with additional competency measures,
amount of self-reflection and supervision etc.).
Discussion: The model and the assessment tool reached
enough empirical evidence to proceed to a more detailed
study of CBT-competencies and their development in
training. Further studies therefore, will deal with the
comparison of self ratings by therapists in training with
ratings of their competencies by superv
210
PA 19-02
A randomised controlled trial comparing
Internet-Based training with self-Reflection or
supervision to a delayed-training control
Sarah Rakovshik 1; Freda McManus1; Dennis Ougrin2
1
Oxford University, United Kingdom; 2Kings College
London, United Kingdom;
This trial examines the effectiveness of Internet-based
training (IBT) in cognitive behavioural therapy (CBT) for
practicing clinicians in Russia and the Ukraine (N = 71).
The primary aim is to investigate the effect of a training
package consisting of Internet-based training (IBT)
(approximately 20 hours over the course of three months)
with either self-reflection or supervision by Skype from
an experienced CBT therapist. Therapist participants were
randomized into three groups: (1) ‘delayed-training’ control
(2) Internet-based training with self-reflection (IBT-R), and
(3) Internet-based training with CBT supervision (IBT-S).
There was a significant interaction of time and condition
(DT vs. IBT-R vs. IBT-S) for both therapist competence
measures, and patients’ clinical outcomes. Results of this
study indicate that IBT programmes may be a scalable and
effective method of disseminating CBT into routine clinical
practice (RCP), particularly for populations without ready
access to more traditional ‘live’ methods of training. The
positive effects of IBT on therapists’ demonstrate that IBT
can remain effective even when therapists must generalize
and maintain skills in RCP across a variety of clinical
presentations. There is also evidence that supervision
adds additional benefit during IBT training. In particular,
the patients of therapists with supervision (IBT-S) achieved
better outcomes than those of the delayed training control
(DT) on four out of five clinical measures, whilst there was
no difference with the control for therapists receiving only
IBT plus self-reflection (IBT-R).
EABCT 2012
Saturday September 1
Paper Session 19 - Training and supervision
in CBT
The CTP Model: A Pragmatic Approach
to Learning and Supervision in Cognitive
Behavioural Therapy
Sanjay Rao1
1
Dalhousie University, Halifax, Canada
Cognitive Behavioural Therapies are now part of evidence
based mental health care. However there is scanty literature
on effective methods and models for training in CBT. The
CTP model is based on heuristic learning of competencies
and is open to development of new competencies. C
stands for condition and conceptualisation. T stands
for techniques and P stands for processes both
transdiagnositic and transtheoretical. C learning requires
learning the background information on the particular
mental health condition. They also need to learn the
generic and condition specific CBT conceptualisation. For
T learning the practitioners focus on standard protocol
techniques for each condition. The supervisor’s role is
to ensure that the general and specific competencies are
developed through role plays, video feedbacks as well
as discussions on the details of the techniques. For P
learning the practitioners need to demonstrate theoretical
knowledge, conceptualisation and over learned skills
related to common mental health problems (i.e the C &
T learning levels). P learning is then encouraged by the
supervisor. Process competencies help the therapist
evolve into an advanced expert. Transdiagnostic process
competencies refer to skill to deal with phenomena at a
psychological function level rather than a diagnostic level
for example intrusions rather than obsessive compulsive
disorder. Transtheoretical competencies are techniques
derived from schools other than CBT but may be used
profitably in a formulation based CBT context. The CTP
model offers an explicit template for development of basic
and advanced psychotherapists.
A Pilot Study of an Arabic Spoken Ten Day
Introductory CBT Practitioner Training Course in
the West Bank, Palestine
Alan Kessedjian1; Samah Jabr2
1
NHS, Birmingham, United Kingdom; 2The Guidance and
Training Center for the Child and Family, Birmingham,
United Kingdom
Introduction: “Institution building under duress
has been the Palestinian response to the challenge of
decades of statelessness, military occupation and forced
diasporization” (Ateek and Rantisi, 2006)
In 2009, Dr Samah Jabr and her colleagues from an NGO
in Bethlehem, the Guidance and Training Centre (GTC)
for the Child and Family, alongside Dr Alan Kessedjian a
British Clinical Psychologist, CBT Trainer and Supervisor
set to the task of developing a cross culturally integrated
CBT Training Programme in the West Bank.
Objectives: To provide a basic level culturally sensitive
Introductory Practitioner Course in CBT for Palestinian
Mental Health Professionals.
To contribute towards laying down the foundations for
further training opportunities, accreditation and the
establishment of a small but vibrant CBT community in
the West Bank and East Jerusalem.
Methodology: The course was pitched at level 2 of the
UK CBT Competency Framework. The ten day course was
over 12 months and involved ten taught days, over three
teaching blocks, with monthly group supervision. The
six day course was over a 6 month programme with two
teaching blocks, with monthly group supervision. Both
courses involved lectures, role plays and interactive group
work and the opportunity to submit tapes applying the
CTS-R to individual clinical practice.
Results: The 10 day programme ran between November
2009 and December 2010, 9 participants completing the
training.
The 6 day programme ran between September 2010 and
February 2011, with a further 6 participants completing the
training.
Conclusion: This training has helped 16 Palestinian
mental health professionals receive a basic training in
CBT. With further support from the International CBT
Community a more vigorous and comprehensive CBT
Professional Training Programme, is the next challenge.
EABCT 2012
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PA 19-03
PA 20-01
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20
Posttraumatic stress disorder (PTSD) in mothers
following their child’s chronic (mental) health
diagnosis: cognitive and non-cognitive predictors
Antje Horsch1; Penny Hazell2; Rachel Woolrich2
1
University of Lausanne, Switzerland; 2University of
Oxford, United Kingdom
Introduction: The experience of having a child diagnosed
with a chronic illness, such as type 1 diabetes mellitus or a
chronic mental health problem, such as anorexia nervosa,
can negatively impact on the mother’s well-being and trigger
posttraumatic stress symptoms (e.g. Horsch, McManus,
Kennedy & Edge, 2007). To date, the role that cognitive and
non-cognitive factors play in predicting the occurrence of
PTSD in these mothers has not been examined.
Objectives and Methodology: Two studies investigated
the prevalence of mothers’ anxiety, depression and PTSD
symptoms triggered by their child’s recently diagnosed
Type 1 Diabetes or eating disorder, and identified individual
diabetes-related or eating disorder-related traumatic
stressors. Furthermore, the relationship between both noncognitive (trauma severity, psychiatric history and history of
trauma, and social support) and cognitive factors (negative
cognitive appraisals and dysfunctional strategies) and PTSD
symptoms in mothers was investigated. Participants were
interviewed using the SCID-DSM-IV-PTSD module, and
completed the PDS and HADS.
Results: Prevalence rates of PTSD, anxiety and depression
in participants were greater than those among women in
the general UK population. Regression analyses found that
cognitive variables explained variance in PTSD symptoms
over and above that contributed by the non-cognitive
variables.
Discussion and Conclusion: The studies highlight
the significant emotional impact a diagnosis of a chronic
(mental) illness in children can have on their mothers, and
identifies a population with clinical needs. The theoretical
implications with regards to the cognitive model of PTSD,
as well as the clinical implications with regards to early
detection of and therapies for PTSD in this population are
discussed.
PA 20-02
Cool dad – great dad? The association between
father’s social anxiety and the social anxiety of
their children
Noortje Vriends1; Susan Bögels1; Mirjana Majdandžiæ1;
Wiekede Vente1; Johan Ormel2;Tineke Oldehinkel2
1
University of Amsterdam, The Netherlands; 2University
Medical Center Groningen, The Netherlands
There is little doubt that Social Anxiety Disorder (SAD) runs
in families. However, the role of fathers in this transmission
process is relatively unstudied in comparison to the role of
mothers. According to the father model of social anxiety
(Bögels & Perotti, 2011), children rely for social anxiety
more on paternal social threats signals, because fathers
are evolutionary specialized in external protection (e.g.,
confronting the external world), which is relevant for social
anxiety. The present study investigated the association
between paternal social anxiety and social anxiety of their
children in a representative community-based sample with
1190 fathers and their children (+- 19 years). Is father’s
actual social anxiety, measured with the 18-item Social
Phobia and Anxiety Inventory (SPAI-18), associated
with his child’s social anxiety (Revised Child Anxiety and
Depression Scale (RCADS) and/or DSM-IV social anxiety
disorder (CIDI)? Further, it is investigated if this association
is moderated by father’s actual engagement with his child,
by parenting style of the father (overprotection, challenging)
and/or by the child’s birth order, and the specificity of these
effects. Data are derived from the fourth wave of the TRacking
Adolescents’ Individual Lives Survey (TRAILS). Results will
be presented and discussed in the light of the formal model
of paternal influence on childhood social anxiety.
PA 20-03
The Efficacy Of Cognitive Behavioral Parent
Training Program On Mothers’ Parental SelfEfficacy And Symptoms Of Oppositional Defiant
Disorder
Mahboobeh Fathabadi1; Karineh Tahmassian1; Mahmood
Heidari1; Wiekede Vente1
1
Shahid Beheshti University, Tehran, Iran
Adolescence is an important transition phase and
adolescents are at risk of many mental health problems.
On the other hand perceived parenting efficacy plays a key
role in management of the challenges as their children
grow up. The aim of the present study was to examine the
efficacy of cognitive behavioral parent training on mothers’
parental self-efficacy and symptoms of oppositional
defiant disorder in teenage girls. participants consists of
212
EABCT 2012
Saturday September 1
Paper Session 20 - Parental self efficacy
and anxiety
The Influencing Factors Of Parental Self-Efficacy
In Mothers of Children Under 2 Year Old
Karineh Tahmassian1; Asieh Anari1; Mahmood Heidari1
1
Shahid Beheshti University, Tehran, Iran
Perceived parental self-efficacy plays an important role
in adaptation to parenthood. Mothers with belief in their
parenting capabilities experience more emotional well
being, closer attachment to their baby. Parental selfefficacy also serves as a protective factor to prevent child
behavioral problems. The aim of the present research is to
examine the influencing factors of parental self-efficacy in
mothers with children under 2 years old. 250 mothers were
selected by multistage sampling method. They completed
Parenting Stress Index, Sources of Social Support
Scale, Maternal Efficacy Questionnaire, Beck Depression
Inventory and Child Temperament Questionnaire. Stepwise
regression analysis showed that temperament of the child,
mother’s depression and parental stress, in three steps,
could explain 33% of variance in maternal self-efficacy. The
finding in the present study provides a convincing reason
for interventions based on parental stress management,
mothers depression and parent management training.
EABCT 2012
The emotional experience associated with
worrying in adults, children and adolescents
Marianna Szabo1; Samuel Fowler1; Imogen Carr1
1
University of Sydney, Australia
Introduction: Among adults, normal and pathological
worrying has been found to be associated with a unique
emotional state involving irritability, restlessness, and
difficulty relaxing. This emotional state is empirically
distinguishable from anxiety and depression, and is
indexed by the Stress scale of the Depression Anxiety
Stress Scales (DASS; Lovibond and Lovibond, 1995).
Conversely, worrying is not strongly associated with the
hallmark autonomic arousal symptoms of anxiety. This
pattern of associations is consistent with suggestions
that worrying serves a cognitive avoidance function in
adults (e.g., Borkovec, et al., 2004). Among children and
adolescents, however, the nature, function, and emotional
experience associated with worrying has not yet been
clearly documented.
Objectives and Method: Currently, no self-report measure
of ‘stress’ is available for youth. Therefore, we created
simplified versions of the adult DASS to maximize
comprehension by adolescents (N = 340) and 7-12-yearold children (N = 367). We explored whether an adultlike ‘stress’ syndrome could be observed in youth via
self-report, and whether this emotional state has specific
associations with worrying.
Results: In the adolescent sample, analyses revealed a threefactor structure underlying the simplified questionnaire,
consistent with the structure of the adult DASS. Worry had
a unique association with Stress. Adolescents who worry
more reported higher levels of irritability, restlessness and
difficulty relaxing, while the autonomic arousal symptoms
of anxiety had consistently low associations with worrying.
In children, however, ‘stress’ could not be identified as a
unique emotional state, and worrying was more strongly
associated with symptoms of anxiety.
Discussion: The process and function of worrying in
adolescents may be similar to that previously identified in
adults. However, further research is needed to delineate the
nature of worrying in 7-12-year-old children.
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PA 20-05
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the students of 3 secondary schools in Tehran and their
mothers. The subjects were assessed by youth selfreport questionnaire (YSR) and parental self-efficacy
questionnaire (before and after and in follow-up study). 15
mothers were placed in experimental group and 17 mothers
were placed in control group. Both groups were matched
in terms of teenage girls’ score in YSR questionnaire
and mothers’ parental self-efficacy. Experimental group
received cognitive behavioral parent training program for
8 weeks, single a week session that lasted two hours. The
follow up study was done after 7 weeks. Data were analyzed
by using of Mixed-Anova and revealed that the program
significantly increased mothers’ parental self-efficacy
and significantly reduced the symptoms of oppositional
defiant disorder in teenage girls in experimental group.
Other findings indicated that your defiant teen program
significantly reduced the symptoms of conduct problems
in teenage girls. These findings support the effectiveness
of cognitive behavioral family interventions to deal with
adolescents behavioral problems.
PA 21-01
Papers
21
ACT and PTSD: A Functional Contextual
Approach
Martin Brock1
1
Nottinghamshire Healthcare NHS Trust, Nottingham,
United Kingdom
Clients who have experienced a trauma or who have
been diagnosed with PTSD often struggle with traumatic
memories, difficult emotions and unwelcome thoughts and
as such avoidance or control of these private experiences
tends to be the goal.
It can be seen that the avoidance itself leads to further
struggle and difficulty in living a valued life. One
therapeutic alternative to emotional or experiential
avoidance is acceptance.
Acceptance allows new contexts from which the trauma
survivor may view the world and the self and letting go of
control strategies in the service of well being can lead to
valued and life enhancing behavioural changes.
In Acceptance and Commitment Therapy (ACT), the
function of the private experience is altered rather than
the experience itself. The therapeutic work done in ACT
is specifically designed to foster acceptance in the service
of valued living. This presentation will outline the theory
and application of ACT and explore its use with individuals
diagnosed with PTSD
Supporting Citations:
Hayes, S.C, Strosahl, K.D., & Wilson, K.G. (2012).
Acceptance and commitment therapy: The process and
practice of mindful change (2nd edition). New York, NY:
The Guilford Press
Orsillo, S. M., & Batten, S. V. (2005).Acceptance and
commitment therapy in the treatment of posttraumatic
stress disorder. Behavior Modification,29(1), 95-129
Walser, R., & Westrup, D. (2007). Acceptance &
Commitment Therapy for the Treatment of PostTraumatic Stress Disorder & Trauma-Related Problems: A
Practitioner’s Guide to Using Mindfulness & Acceptance
Strategies. Oakland, CA: New Harbinger.
PA 21-02
PTSD and Depression Symptom Trajectories
Overlap After Sexual Assault
Teresa Au1; Benjamin Dickstein1; Laina Rosebrock2; Maria
Steenkamp2; Brett Litz2
1
Boston University, USA; 2VA Boston Healthcare System,
USA
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A systematic review and meta-analysis of the
long-term course of Post-Traumatic Stress
Disorder
Nexhmedin Morina1; Jakob Lobbrecht1; Jelte Wicherts1;
Stefan Priebe2
1
University of Amsterdam, The Netherlands; 2Queen Mary
University of London, United Kingdom
Introduction: Several studies have been published on the
natural course of Posttraumatic Stress Disorder (PTSD).
This study offers the first systematic review and metaEABCT 2012
Saturday September 1
Paper Session 21 - Different interventions
for PTSD and longitudinal outcomes
Introduction: Recent theoretical models propose that
co-occurring PTSD and depression after trauma may be
best conceptualized as a single traumatic stress construct,
rather than two distinct responses. However, research
investigating overlap between these disorders has
been methodologically limited and has rarely examined
concordance rates between longitudinal symptom
trajectories.
Objectives and Methodology: We sought to test the
extent to which longitudinal trajectories of PTSD and
depression symptoms overlap in a sample of recent
sexual assault survivors. PTSD and depressive symptom
trajectories were derived from two previous studies
conducted with the same sample of sexual assault survivors
(N=119). Participants completed online assessments 1, 2,
3, and 4 months after the assault. PTSD symptom severity
was assessed with the PTSD Checklist, and depression
symptom severity was assessed with the Depression and
Anxiety Stress Scale.
Results: PTSD and depression symptom trajectories were
highly concordant (Chi-square=42.59, df=1, p<.001).
The majority of participants (86%) could be classified
in the same type of symptom trajectory for PTSD as for
depression (e.g., chronic trajectories for both PTSD and
depression symptoms). The remainder were classified in
discordant trajectories (e.g., chronic PTSD but recovering
from depression).
Discussion: Among sexual assault survivors, PTSD
and depression trajectories are highly overlapping and
follow similar time courses. We will discuss possible
explanations for those who experienced discordant PTSD
and depression symptom trajectories, as well as the
clinical implications.
Conclusion: Although these results do not directly speak
to whether PTSD and depression are distinct constructs,
the high degree of overlap between participants’
trajectories is consistent with recent studies suggesting
that PTSD and depression may be manifestations of the
same underlying pathology, rather than independent
posttraumatic sequelae.
Writing therapy for posttraumatic stress: A metaanalysis
Arnold van Emmerik1
1
University of Amsterdam, The Netherlands
Background: Research on therapeutic writing has mainly
focused on the writing paradigm developed by James
W. Pennebaker. Previous meta-analytic research showed
that this brief intervention is not effective in reducing
posttraumatic stress (PTS). This meta-analysis therefore
investigated the efficacy of more extensive writing therapies
for PTS. In addition, data analysis (intention-to-treat or
completer), study design (controlled or uncontrolled),
mode of delivery (internet or face-to-face), pretreatment
symptom severity, and time since trauma were examined
as effect size (ES) moderators.
Methods: The literature was searched using several
structured and unstructured strategies, including keyword
searches of the PubMed, Web of Science, PsycINFO, and
PILOTS databases. Ten studies met eligibility criteria and
were included in the analyses. These studies included a
total of 1166 participants, of which 837 were assigned to
writing therapy.
Results: Compared to waitlist control (WLC), writing therapy
resulted in significant and substantial short-term reductions
in PTS and comorbid depressive symptoms, and these
reductions were maintained at follow-up. Writing therapy
was as efficacious as trauma-focused cognitive behavioral
therapy (TFCBT), but this finding was based on few direct
comparisons. No ES moderators could be identified.
EABCT 2012
PA 21-05
Music Therapy via Remote Video Technology: An
Interdisciplinary Approach to Treating Complex
PTSD
S. Kathleen Bailey1; AaronLightstone2; Peter Voros3
1
Lakehead University, Canada; 2Sunnybrook Health
Sciences Centre, Toronto, Canada; 3Thunder Bay
Regional Health Sciences Centre, Canada
Introduction: Mental health services have been
effectively delivered to residents living in remote and
underserviced areas using telehealth, but active interprofessional collaboration using these technologies is
rare. Objectives: To describe the process, outcomes, and
address the mode-specific challenges of CBT combined
with remotely delivered music therapy to address
symptoms of complex Post Traumatic Stress Disorder
(PTSD) with comorbid Major Depressive Disorder (MDD).
Methodology: Retrospective case review. Results: Music
therapy sessions (N=24) were co-facilitated by a Music
Therapist and Clinical Psychologist and were held as realtime video conferences utilizing the Ontario Telehealth
Network. Sessions took place despite a geographic
distance of 1400km between the client/Psychologist and
the Music Therapist. Psychotherapy was ongoing between
music therapy sessions.
Outcomes: In conjunction with other supportive
therapies, the client reported significant improvement
in his ability to manage many of his PTSD symptoms
including sleep disturbance, emotion regulation,
interpersonal relationships and social avoidance, and
negative affectivity, among others.
Discussion: Unique challenges related to the delivery
of collaborative psychotherapy and music therapy were
overcome. Prospective experimental research to elucidate
aspects of the treatment important for promoting recovery
is warranted.
Conclusions: Based on this experience: a) remotelydelivered music therapy can be effective in the treatment of
complex PTSD, b) inter-professional collaboration made
a positive impact on the treatment process, c) geographic
distance need not be an obstacle to effective treatment,
and d) a remote treatment modality was not detrimental for
treatment efficacy.
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Conclusions: Writing therapy is an empirically supported
treatment for PTS, and may constitute a useful treatment
alternative for patients who do not respond to current
treatments of choice or for whom these treatments are not
readily available. Future studies might compare writing
therapy to current treatments of choice, and evaluate
writing therapy in specific at risk populations such as
military veterans.
Papers
regression analysis of available research on the long-term
natural course of PTSD ant its predictors.
Methodology: Data sources were comprehensive
computerized literature search (PubMed, PsycInfo, Pilots,
and Psyndex), hand searches, and contact with authors.
All observational prospective studies on the course of
PTSD following any kind of traumatic stress with a followup of at least 10 months were included.
Results: Results of 33 studies included into the metaanalysis indicated substantial variation in the overall decline
of current PTSD cases across studies. Approximately half
of individuals diagnosed with PTSD at the first assessment
did not meet criteria for PTSD at follow-up after a mean of
27 months. A larger proportion of male participants and/or
employed participants were associated with maintenance
of PTSD. War related traumata predicted a chronic course
and the death of a significant other and mixed trauma
predicted less chronicity.
Discussion: The findings indicate that PTSD is has a less
chronic course than previously assumed. Implications for
assessment and treatment of PTSD will be discussed.
Paper Session 22 - Neuroscience and
psychopathology 1
PA 22-01
Papers
22
Neuroscience and auditory verbal halluciantions.
State of the art treatment
Angela Ganci1; Antonella Montano1
1
Istituto Beck, Rome, Italy
Introduction: Hallucinations are a very common
symptom in schizophrenia, even if studies show that some
10–15% of the healthy population can experience auditory
verbal hallucinations (AVHs) (Sommer et al., 2010).
To explain the question, differences in patient and nonpatient populations and neurological alterations implicated
in the experience of AVHs have been investigated (e.g.
Larøi, 2012).
Objectives: This study investigates the current researches
in the field of auditory verbal hallucinations, with regard to
neural correlates and effective treatments
Methodology: A bibliographic analysis is utilized,
through the examination of outcome studies
Results, Discussion and Conclusion: Underlying
mechanisms involved in development of AVHs still remain
uncertain.
The Continuum Hypothesis suggest the mediation
of beliefs or appraisals and coping strategies, as two
psychological mechanisms which allow to discriminate
between clinical and non-clinical conditions.
Regarding the neural basis of AVHs, distributed brain
network has been shown to be implicated in the experience
of AVHs.
Neuroimaging studies found an involvement of frontotemporal and medial temporal areas, secondary and
primary sensory cortices, and subcortical regions.
Functional connectivity (FC) studies show a contribution
of a complex functional loop, including Wernicke’s area
and the putamen, resulting in conscious hallucinations of
speech.
Among therapeutic approaches, antipsychotic medication
induces a quick decrease in symptom severity, but has a
highly rate of nonadherence.
Transcranial magnetic stimulation (TMS) is a potentially
useful treatment method in reducing the frequency and
severity of AVHs, and cognitive-behavioral therapy
(CBT), combined with antipsychotics, helps to decrease
catastrophic appraisals and develop new coping strategies.
While several studies showed clinical improvement due to
therapeutic resources, a specific reduction in hallucination
severity has never been proven.
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PA 22-02
Sloreta findings in patients with panic disorder
before and after coginitive behavioural treatment
- case series
Dana Kamaradova1; Jan Prasko1; Ales Grambal1; Tomas
Diveky1
1
University Hospital Olomouc, Czech Republic
Introduction: Panic disorder is frequent psychiatric
disorder characterized by sudden and unexpected onset
of a panic attack, characterized by terror or impending
doom, and associated with many somatic symptoms.
Panic is considered as a state of hyperarousal, the EEG
has had a prominent place in anxiety studies. sLORETA
(standardized low resolution brain electromagnetic
tomography) is now widely used research method
investigating the electrical activity of the brain with zero
localization error and ability to reconstruct multiple
resources.
Method: We measured patients with Panic disorder.
Diagnosis was confirmed by M.I.N.I. (MINI-international
neuropsychiatric interview). Patients were treated both
by psychotropics and CBT (cognitive behavioral therapy)
for six week. The symptoms intensity was assessed using
BAI (Beck Anxiety Inventory) and BDI (Beck Depression
Inventory). They were also examined by EEG. It was
measured in rest state with closed eyes, using standard
10-20 montage with 19 electrodes. Measurements were
carried out at the beginning and after 6 weeks of therapy.
Results: We found decreased absolute power in alfa-2
(10.5 – 12 Hz) activity in anterior cingulated (Brodmann
area 32), and increased absolute power in beta-3 (21.5 –
30 Hz) activity in superior frontal gyrus (Brodmann area
8).
Conclusions: Increase of beta-3 activity may be
interpreted as a gain conscious control of emotions,
decrease of alpha-2 activity is an expected finding,
because the anterior cingulate seems to be important in
regulation of autonomic reaction of the organism. Our
findings suggest that cognitive behavioural psychotherapy
can cause changes in brain activity.
Supported by IGA MZ CR NT 11047-4/2010
PA 22-03
An Evaluation of the Use of Cranial Electrotherapy
Stimulation in the Alleviation of Anxiety Disorders
Lesley Parkinson1
1
Brainhealth, The Diagnostic Clinic, London, United Kingdom
Anxiety and anxiety disorder are both psychological
and physiological conditions. Psychological therapies,
EABCT 2012
Bodily stimulation has effects on brain
processing
Claudia Hoepfner1
1
Berlin, Germany
Here a general integrative approach concerning the psyche
shall be introduced. The model presented can be well
embedded in bioevolutionary principles. It is to further
scientific enterprises and health interventions as the goal
of psychology is to help and support people in need.
Abstract of research: In an investigation three facets
of body contact, more specifically, of an embrace (check
work by Uvnäs-Moberg) where modelled in a rather
technical way. There are different reasons for avoiding an
interpersonal design. The facets modelled where: pressure
to stomach (pressing a tissue around one’s own body),
warmth (warm water bottle) and softness (soft blanket
an chair). So, there where two groups, one group had all
the three stimuli in combination, the other had none of
them. Again, there are reasons for this, and limitations
to account for. Each participant was recorded on EEG in
a solo session. The result is that in the group with body
stimuli a shift of brain alpha and theta could be found to
the right hemisphere. As designated by Shore the right
hemisphere is especially concerned with and connected
to limbic and bonding functions in children and adults.
EABCT 2012
PA 22-05
Reactions to Ostracism: Gender and endocrine
profies
Liat Helpman1; Julia Penso2; Ruth Feldman1; Orna
Zagoory-Sharon1; Eva Gilboa-Schechtman1
1
Bar Ilan University, Israel; 2The Sami Shamoon College
of Engineering, Beer Sheva, Israel
Ostracism is a potent social experience. Empirical support
for its dire consequences includes self-reported distress
(e.g., Zadro et al., 2004), changes in behavior (CarterSowell et al., 2008), and changes in neural activity (Crowley
et al., 2010). Endocrine reactivity to social stressors has
also been repeatedly demonstrated with cortisol (C, e.g.,
Dickerson & Kemeny, 2004). In addition, Testosterone (T),
an established marker for dominance (e.g., Schultheiss,
2007), has been tied to reactivity to social status threat
(Mehta, Jones & Josephs, 2008), and interacts with C
in such reactivity (Mehta & Josephs, 2010). Both C and
T reactivity appears to be gender-dimorphic (Kajantie &
Phillips, 2006; Mehta & Josephs, 2010).
We sought to examine gender-specific and non-gender
specific endocrine reactions to ostracism. To this end we
analyzed saliva samples for C and T as well as salivary
alpha amylaze, a promising non-gender-specific marker of
stress reaction (sAA; e.g., Vigil et al., 2010), and estradiol,
a promising marker of female dominance (E, Stanton
& Schultheiss, 2007). Participants (n=44, 23 females)
experienced ostracism in an computerized ball-toss game.
Saliva samples were collected before and at several time
points after this game. Values reflecting levels directly
before and just after the experience were analyzed for all
markers, with C and sAA additionaly analyzed to reflect
levels 15 minutes after the experience. We found sAA
reactivity to ostracism in both males and females, whereas
C was reactive in males only. C, T, and their interaction
predicted C changes among males, but not females. sAA
and E interacted in predicting changes in sAA among
females, and sAA and T interacted in predicting changes
in sAA among males, but not females.
A brief induction of ostracism resulted in significant
changes in endocrine activity, with individual differences
in gender and dominance involved in this response.
Results are discussed within an evolutionary framework.
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Devinsky points towards the right brain as most important
for psychic processes concerning at the same time body
feel, conscioussness, and self.
Papers
in particular Cognitive Therapy and Relaxation are well
established as treatment modalities.In general terms,
anxiety describes uneasiness, apprehension, fear and
worry, in circumstances that don’t necessarily warrant it,
and often, without an immediately identifiable triggering
factors. Sufferers often find themselves completely unable
to escape their concerns. There are often accompanying
symptoms, such as heart palpitations, fatigue, headaches,
muscle tension, irritability, and sweating. Alongside the
physical symptoms, there are a whole host of emotional
ones that develop and often increase in seriousness as
periods of anxiety increase. These include increasing
feelings of dread, loss of concentration, and a distorted
view of the severity and nature of specific situations, and
how to manage these judgements and situations.
The study that will be presented here involves 2 groups an experimental anxiety group and a symptom free control
group. Rating scales were used to evaluate levels of
anxiety, stress and depression pre and post intervention.
The anxiety group used a cranial electrotherapy stimulator
to increase slow-wave activity in the brain, in particular
the alpha-wave activity which is associated with a state of
calmness and relaxation.Pre-post treatment alpha wave
levels were compared with the alpha wave levels of the
control group.
Paper Session 23 - Mindfulness:
Assessment and treatment
PA 23-01
Papers
23
Mindfulness-Based Cognitive Therapy reduces
residual depressive symptoms irrespective
of number of prior depressive episodes. A
randomized controlled trial
Nicole Geschwind1; Frenk Peeters2; Marcus Huibers3; Jim
Van Os3; Marieke Wichers3
1
KU Leuven, Belgium; 2Maastricht University Medical
Centre, The Netherlands; 3Maastricht University, The
Netherlands
Introduction: Teasdale and colleagues (Ma & Teasdale,
2004; Teasdale, et al., 2000) have published findings on
differential subgroup efficacy, indicating that MindfulnessBased Cognitive Therapy (MBCT) only works for patients
with a history of three of more prior depressive episodes
(hereafter: 3+). Since then, patients with only 1 or 2
prior depressive episodes (hereafter: 2-) have been
systematically excluded from most MBCT trials.
Objectives and Methodology: To investigate whether
exclusion of 2- patients from MBCT trials and treatment
is justified, adults with a life-time history of depression
and current residual depressive symptoms (mean age
= 43.9 years, SD = 9.6; 75 % female; all Caucasian)
were randomized to MBCT (n = 64) or waitlist control
(CONTROL; n = 66) in a parallel, open-label, randomized
controlled trial. Randomization occurred within subgroups:
≤ 2 prior episodes (n = 71) vs. ≥ 3 (n = 59). Primary
outcome measure was reduction in residual depressive
symptoms, measured using Hamilton Depression Rating
Scale (HDRS-17) and Inventory of Depressive Symptoms
(IDS).
Results: The interaction between treatment and subgroup
was not significant (p > .2). Regarding reduction of
residual depressive symptoms, MBCT was superior to
CONTROL across subgroups (p < .001). Effect sizes of
MBCT compared to CONTROL were even nonsignificantly
larger in the 2- than in the 3+ group (HDRS: d = -.74 vs.
-.29; IDS: d = -.60 vs. -.26, respectively); findings can
thus not be attributed to too low power.
Discussion and Conclusion: In a sample of participants
with residual depressive symptoms, we found no evidence
for increased efficacy of MBCT in participants with 3 or
more compared to 1 or 2 prior episodes, challenging the
recent practice of excluding patients with less than three
prior episodes from MBCT trials and treatment. Residual
depressive symptoms after only one or two episodes of
depression may thus be sufficient to suggest MBCT
treatment.
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PA 23-02
Can mindfulness-based teacher competency be
assessed with reliabilty and validity?
Catrin Eames1; Rebecca Crane2; Willem Kuyken3; Jim Van
Os3; Marieke Wichers3; J. Mark. G Williams4
1
University of Liverpool, United Kingdom; 2Bangor
University, United Kingdom; 3University of Exeter, United
Kingdom; 4Oxford University, United Kingdom
Introduction: Whilst there is increasing recognition of
the benefits of mindfulness-based interventions applied
in various contexts, and its widespread dissemination
and training internationally, there remains a paucity in the
literature regarding the methods with which to achieve
best outcomes. The degree to which an intervention
is implemented as intended is key to the successful
dissemination of evidence-based interventions in
naturalistic settings. Central to this assumption is the skill
with which an intervention is delivered – the degree of
practitioner competence in implementing an intervention
effectively. Whilst training and on-going supervision are
core elements in fostering competence, a valid and reliable
method of its assessment is required in order to adequately
describe what occurs during intervention delivery and can
help identify further training needs.
Objectives and methodology: The Bangor, Exeter,
and Oxford Mindfulness-Based Interventions – Teacher
Assessment Criteria (MBI-TAC) was developed to
measure mindfulness-based teacher competency that can
be applied in both educational and pragmatic intervention
delivery settings. This paper describes the MBI-TAC and
its development, and presents its psychometric properties.
MBCT and MBSR teachers on post-graduate mindfulnessbased training programmes consented to assessments
of their teaching being made available for the research.
Assessments were conducted by three UK University
mindfulness teaching and training teams.
Results: The MBI-TAC demonstrates good internal
consistency, high inter-rater and code-recode reliability,
and discriminant validity.
Discussion and Conclusion: The MBI-TAC attempts to
address the need to assess mindfulness-based teaching
competency and intervention integrity. This is an initial
step in quantifying mindfulness-based teacher competency
skills, with further research required to evaluate the clinical
implications relating to intervention outcomes.
EABCT 2012
Mechanisms of mindfulness and mental health:
The RICH model
Ivan Nyklicek1
1
Tilburg University, The Netherlands
Effectiveness of Mindfulness based Relationship
Enhancement on Couples’ Acceptance and
Marital Adjustment
Niloufar Esmaeilour1; Fereshteh Mootabi1; Mahmoud
Heidari1; Mansoureh alsadat Sadeghi1
1
Shahid Beheshti University, Tehran, Iran
Theoretical models have been developed regarding the
working mechanisms via which mindfulness may have its
beneficial effects on mental health. However, some crucial
direct effects of mindfulness, which may form intermediate
paths between mindfulness and mental health, seem to
be missing. Therefore, a new model is proposed, based
on previous models, Buddhist thought, and meditation
experience.
This model incorporates four central direct effects. The first
is Relaxation (R), a direct effect of the accepting attitude of
mindfulness, although not always present in the first stages
of mindfulness practice. The second is Insight (I) into one’s
psychological processes, which is prominent in the original
Buddhist thought and a central factor of the anti-rumination
effect of mindfulness. The third direct effect is Contact
with reality (C). Open, accepting mindfulness leads to full
contact with what is happening in the present moment, both
internally and in the external environment. This full contact
is associated with a sense of connectedness with what is
perceived. Compared to Insight—reflecting a somewhat
distant perspective—, Contact implies fundamental intimacy.
The final direct effect is Harmony (H) between the various
subsystems of one’s body-mind system as well as between
this system as a whole and the surrounding environment.
This is a direct effect of the open and accepting attitude of
mindfulness. Compared to Relaxation (R), referring to one’s
own system, Harmony (H) encompasses also the external
reality.
These four effects, which are interrelated, together comprise
the RICH model of mindfulness’ central direct effects, which
are conceived of as intermediate paths leading to other
effects promoting mental health, which have been previously
described, such as (self)compassion, experiential approach,
and self-regulation. The RICH model provides a theoretical
framework that may guide research into the working
mechanisms of mindfulness.
EABCT 2012
Introduction: Mindfulness based interventions are not
only used for clinical population, but also are known as
effective preventive and promotional programs. Partners’
relationship is affected by their judgment, acceptance or
rejection. Mindfulness can improve partners’ copings with
stress, and their ability to conflict resolution.
Objectives: The purpose of this study was investigating
the effectiveness of mindfulness based relationship
enhancement on increasing marital adjustment and
acceptance of partners.
Methodology: This study was a semi-experimental
study with pre-test, post-test, and control group. 30 nondistressed volunteer couples (score 91 and higher on
Luck & Wallace Marital Adjustment Test) were assigned
randomly in experimental and control groups. Experimental
group participated in eight 2-hour sessions as well as a
full session (6 hours a day), between 6th and 7th week.
All subjects completed Intimate Partner AcceptanceRejection and Control, Luck & Wallace Marital Adjustment
Test, before and after the intervention. Data were analyzed
using Chi-Square and MANCOVA.
Results: The experimental group’s total scores of
acceptance and marital adjustment were significantly
increased in post-test (p 0.001). Additionally, the
intervention had significant effect on decreasing the
scores of cold, hostility/aggression, indifference/neglect,
and undifferentiated rejection subscales. In women, the
intervention had not significant effect on control variable;
whereas in men, the score of control subscale decreased
significantly.
Discussion and Conclusion: Mindfulness increases the
acceptance of internal and external events nonjudgmentally.
So, by practicing mindfulness, partners can accept each
other more than the past. Increasing acceptance can
result to increasing marital adjustment directly; and via
promoting empathy, marital satisfaction, cohesion, and
closeness.
219
23
PA 23-04
Papers
PA 23-03
PA 23-05
Preparing the Iranian version of group
Mindfulness based cognitive therapy protocol
and it’s effectiveness on depression with suicidal
thoughts
Maryam Hanassabzadeh Esfahani1
1
Tehran Psychiatric Institute, Iran
Papers
24
Aim: Meta analysis researches finding, indicated that
traditional cognitive approach are not effective in suicidal
thought. Major aim of present study was Preparing of
group Mindfulness based cognitive therapy (MBCT)
protocol modified Iranian culture, as a new cognitive
approach for depression & determining it’s effectiveness
on depressed patient with suicidal thoughts.
Methods: In a queasier experimental design, 26 patients
diagnosed with major depressive disorder with suicidal
thoughts recently, based on DSM-IV criteria and structured
clinical interview( SCID) were assigned in experimental
and control groups. All patients were assessed with the
Beck Depression Inventory (BDI) and Beck Suicide Scale
inventory (BSSI). Then the treatment protocol provided
by Hnasabzadeh and colleagues in previous research,
with appropriate consideration of the Iranian culture,
moderated & experimental group received 10 sessions
2 hour MBCT that was according this treatment protocol.
In regard of ethical consideration waiting list has used
as control group. Then evaluated all of patient at the end
of sessions & only experimental group after 1 month as
follow up. Finally data analyzed by ANOVA& ANCOVA.
Results: Results showed that the experimental protocol
on the treatment group, with a significant difference in
depression severity scores (p<0/001) and the intensity of
suicidal thoughts (p<0/003) in this group than the control
group, was effective . Moreover, the stability of these
results still had to follow up.
Conclusion: It seems, group Mindfulness based cognitive
therapy based on present protocol could be significantly
effective on decreasing depression & suicidal thoughts in
depressed patient with suicidal thoughts and it remains
until 1 month follow up.
220
Paper Session 24 - Social Anxiety:
Assessment and relationships with
other parameters
PA 24-01
High social rank and social anxiety
James Williams1; Glen Bates1
1
Swinburne University of Technology, Australia
Ethological models of social anxiety (Trower & Gilbert,
1989) suggest that social rank is central to social anxiety
and socially anxious individuals orient to relationships
from a competitive (cf. affiliative) perspective. Socially
anxious individuals are thought to be attuned to competitive
aspects of relationships and to believe that they are inferior
(lower social rank) to others. Interestingly, Trower and
Gilbert suggest that some dominant individuals might also
be vulnerable to social anxiety. Cluster analytic studies
indirectly support this, finding that some socially anxious
individuals utilize approach-motivated (cf. avoidancemotivated) strategies (e.g., impulsivity, exploratory
tendencies and a tendency to engage in risky behaviours)
to deal with social anxieties (Kashdan & Hofmann, 2008).
Social rank might provide an explanation for the difference
between the approach-motivated and the more common
avoidance-motivated socially anxious individuals.
Method/Results: 608 participants (Females=337)
completed measures of social anxiety, social rank and
depression. Using the strategy of Kashdan and Hofmann,
a cluster analysis identified four clusters; one non-socially
anxious and three socially anxious. Two of the socially
anxious clusters reported low (perceived) social rank. One
social anxiety cluster reported higher perceived social
rank. In terms of adjustment, the «high rank» cluster had
lower social anxiety and depression scores than one of the
“low rank” clusters but higher scores than the other. This
indicates that the «high rank» cluster was not simply a
higher functioning social anxiety cluster.
Conclusion: Given the prominence of group therapies
in the treatment of social anxiety and considering social
rank would influence the way individuals relate to others
in the context of group therapy, it may be necessary to
evaluate the efficacy of this type of treatment for both types
of individuals. Modification of standard protocols might
be required.
EABCT 2012
Evidence Based Assessment of Youth Social
Phobia Scales
Bogdan T. Tulbure1 ; Aurora Szentagotai1 ; Anca Dobrean1;
Daniel David1
1
Babes-Bolyai University, Cluj-Napoca, Romania
Shyness and Behavioural inhibition are
associated with social anxiety: The moderating
role of social self efficacy and attachment;
controlling for interpretation bias
Zahra Taherifar1; Mohsen Dehghani1; Ladan Fata2;
Banafsheh Gharaie2
1
Shahid Beheshti University, Tehran, Iran; 2Tehran
University of Medical Sciences, Iran
Introduction: The evidence based assessment (EBA)
approach investigates the empirical support of various
psychological measures. It was designed to investigate
what makes assessment instruments reliable, and to
classify their evidence. As a result, the EBA offers the
empirical arguments for selecting and promoting the
assessment instruments that present the highest support.
Objectives and Methodology: Starting from Hunsley
and Mash’s evaluative framework, in the current study we
critically reviewed the rating scales designed to measure
social anxiety or phobia in youth. The psychometric
characteristics of 13 social phobia rating scales were
extensively investigated.
Results: An overview about the scientific support
accumulated by these scales is offered. After carefully
analyzing the evidence, we rendered the Social Phobia and
Anxiety Scale for Children (SPAI-C) and the Social Anxiety
Scale for Adolescents (SAS-A) as the most empirically
supported measures of youngsters’ social anxiety. Our
results are consistent with previously obtained data.
However, according to our analysis another couple of
scales proved to be empirically supported (i.e., the Social
Phobia Inventory – SPIN, and the Liebowitz Social Anxiety
Scale for Children and Adolescents – LSAS-CA).
Discussion and Conclusion: As the data regarding
different measurement instruments keeps growing,
scientists should continue to investigate the empirical
support that rapidly becomes available in the literature.
This approach not only allows the new generation of
sound measures to gain an empirically based status, but
also helps researchers and practitioners to make informed
decisions when selecting the assessment tools for their
specific purposes
EABCT 2012
Introduction: Dimensional approach explains social
anxiety on a continuum which is prevalent in normal
population. Social anxiety has some negative effects on
different aspects of life. The aim of the current study was
to examine Rapee and Spence’s model in order to test
moderators of social anxiety in nonclinical population.
Objectives and Methodology: we hypothesized that
the relationship between shyness, behavioral inhibition,
and social anxiety is moderated by social self efficacy and
attachment, and is mediated by interpretation bias (negative
self-evaluation and negative evaluation by others). Four
hundred and thirty eight students of university of Tehran
participated in the study (males=218 & females=220). All
participants completed social phobia inventory, Stanford
Shyness Survey (SSS), Adult Measure of Behavioral
Inhibition (AMBI), Retrospective Measure of Behavioral
Inhibition (RMBI), Consequences of negative social events
questionnaire, Self-efficacy for social situation scale, and
adult attachment scale.
Results: Based on a structural equation modeling
method, a hypothesized model was depicted as shyness
and behavioral inhibition predict vulnerability that, in turn,
predicted social anxiety. This model also proposed that
social self-efficacy and attachment had an moderating
effect on the relations between vulnerability and social
anxiety. In addition, it was proposed that interpretation
bias mediates the relationship between vulnerability and
social anxiety.
Discussion and conclusion: The results of the current
study were found relatively consistent with Rapee and
Spence’s model of social anxiety. This study indicated that
the impact of shyness and behavioural inhibition although
are significant, however seems to be moderated by two
factors of social self efficacy and attachment. Goodness
of fitness indices support the hypothesized model. This
model has clinical implications that would contribute to
modify cognitive behavioural based interventions for
social anxiety accordingly.
221
24
PA 24-03
Papers
PA 24-02
PA 24-04
Transdiagnostic view of emotional disorders:
Shared and distinctive features of depressive
and social anxiety disorders
Ladan Fata1; Ali Ahmadi Abhari1; Shima Ataee1
1
Tehran University of Medical Sciences, Iran
Papers
25
Introduction: Transdiagnosis is a major paradigm for
explaining emotional disorders. While traditional CBT
is more focused on content specificity of anxiety and
depression, transdiagnosis is more focused on unified
cognitive processes. There are many studies supporting
both paradigms, however more studies are necessary to
indicate either distinctive or shared components of anxiety
and mood disorders.
Objectives and methodology: To compare cognitive
psychopathology of Depression and social phobia with
nonclinical sample, 15 patients diagnosed with SAD with
mean age of 23.2 (1.64) and 16 patients diagnosed with
unipolar mood disorder with mean age of 28.5 (3.45)
and 48 nonclinical sample with mean age of 30.14 (7.90)
answered CBAS, BDI, BAI, and RSQ.
Results: Data were analyzed by multivariate analysis of
variance using DSM-IV-TR diagnoses as independent
variable and subscales of each measure as dependent
variables. Findings indicated no group differences in
non-social cognitive avoidance subscale scores of CBAS
(F = 2.36), and distraction subscale scores of RSQ(F =
.466). Depressed group was significantly different from
both social anxiety and nonclinical groups in rumination
subscale scores of RSQ (F = 11.88, p<0.001). Significant
difference in behavioral social avoidance subscale scores
(F = 10.98, p<0.001), behavioral nonsocial avoidance
subscale scores (F = 8.36, p<0.004) and cognitive social
subscale scores (F = 5.40, p<0.007) of CBAS was shown
between two clinical groups and nonclinical group. The
results also indicate that BDI differentiates three groups (F
= 28.37, p<0.001) while BAI differentiates control and SAD
groups from depressed group (F = 5.22, p<0.008).
Conclusion: The current study has shown some overlap
in cognitive psychopathology of unipolar mood disorder
and social anxiety disorder, however rumination is shown
to be the distinctive feature of depression. Results of
the current study are supporting transdiagnostic view of
emotional disorder.
222
Paper Session 25 - Exploration of
psychological characteristics in
anxious and depressed people
PA 25-01
Do patients’ perceptions of a current health
problem differ in somatoform, anxiety and
depressive disorders and if so, does it matter?
Lisbeth Frostholm1
1
Aarhus University Hospital, Denmark
Introduction: The common Sense Model (CSM) is a
widely used theoretical framework to assess patients’
perceptions of their physical illness. However, in recent
years the CSM has increasingly been used in patients with
functional somatic disorders and mental illness.
Objectives: We wished to investigate 1) if primary care
patients’ perceptions of a current health problem differ
according to ICD-10 diagnosis of somatoform, anxiety
and depressive disorders and 2) if the patients’ own
understanding of their health problem as either physical or
both physical/psychological can further distinguish patients
within diagnostic categories, and 3) the possible impact
on health outcomes (use of primary health care, self-rated
health) of different illness perceptions.
Methodology: 1785 patients presenting a new health
problem to one of 38 physicians from 28 General
Practices in Aarhus County, Denmark. Patients completed
a questionnaire on their illness perceptions and emotional
distress before the consultation. A stratified subsample of
701 patients was interviewed by trained medical doctors
using the diagnostic SCAN-interview. Register data was
obtained on use of primary health care in a two-year followup period.
Results: Patients’ own understanding of their health
problem as either physical or both physical/psychological
is highly associated to how they perceive the consequences,
the timeline and the cause of their health problem and
to how they react emotionally independent of the ICDdiagnosis. Furthermore, the patient’s own understanding
and perception predict health outcomes.
Conclusion: Patients’ perceptions of their mental health
problems predict health outcomes and should be included
together with professional diagnostics when making a
treatment plan.
EABCT 2012
An exploration of the relationship between
resilience and cognitive behavioural therapy
(CBT) outcomes for anxiety and depression
in adults with and without adverse childhood
experience in a clinical setting
Zhila Javidi1
1
Flinders Medical Centre, Australia
Longitudinal buffering effects of psychological
well-being on the relationship between negative
appraisals for internal state and generalized
anxiety symptom
Yoshitake Takebayashi1 ; Keisuke Tanaka1; Yoshinori
Sugiura1
1
Hiroshima University, Japan
Research on resilience demonstrates that despite the
presence of known risk factors for developing anxiety and
depression, it is also possible to identify resilience-related
practices that can inform treatment and illness-prevention.
For example, early interpersonal trauma is a known risk
factor for adults developing anxiety and depression.
Yet, not all children subjected to interpersonal trauma
experience mental health problems as adults. Additionally,
some adults respond better and recover more quickly to
evidence based therapies such as CBT compared to others.
Objectives of the research being presented are to explore
relationships between resilience, psychological distress,
level of functioning, and recovery in treatment seeking
adults, with and without adverse childhood experience, to
determine if resilience can be cultivated and if it should be
targeted in treatment and illness-prevention.
A clinical sample of N=200 participants aged 18 to 65
receiving CBT for anxiety or depression is being obtained
from a specialist service. Research design is pre, mid
and post-test intervention. Data is collected using a
semi-structured interview tool in conjunction with a set
of standard measures administered at base-line, with
standard measures repeated at outcome measurement
intervals.
Results and discussion will address the following: Is
there a relationship between resilience and psychological
distress in adults presenting for treatment?, Does
evidence-based CBT improve resilience in adults?
Therefore can it be learnt?, Is there a relationship between
resilience and recovery? Therefore does it matter in
recovery?, Does adverse childhood experience impact
on the relationship between resilience and psychological
distress, improvement in resilience related to CBT and/or
resilience and recovery?
Care will be taken throughout not to shift or ameliorate
perpetrator responsibility for their acts of interpersonal
trauma.
Purpose: Negative appraisals for internal state (fear of
anxiety [FA] and uncontrollability of anxiety [UCA], and
negative beliefs about worry [NBW]) are suggested to be
related to development of generalized anxiety disorder
(GAD). However, longitudinal relationship between these
vulnerability factors and GAD symptom has not yet to
be revealed. In addition, it is suggested that Well-Being
Therapy (WBT) has clinical advantages to the treatment
of GAD, while little is known about buffering effects of
psychological well-being (PWB) on the relationship
between cognitive vulnerabilities and GAD symptom. This
study investigated whether PWB moderate the link between
negative appraisals for internal state and GAD symptom in
longitudinal design.
Method: 297 undergraduate students (female=62%,
age=18.91}1.61) completed following questionnaires
voluntarily: UCA (Anxiety Control Questionnaire-internal
reaction: Rapee et al., 1996), FA (Affective Control
Scale-fear of anxiety: Williams et al., 1997), NBW (Meta
Cognitions Questionnaire 30-negative beliefs about
worry subscale: Wells & Cartwright-Hatton, 2004). GAD
symptom (Generalized Anxiety Disorder Questionnaire-IV:
Newman et al., 2002) and PWB (Japanese adaptation of
Ryfffs scale of Psychological Well-Being: Nishida, 2000).
GAD symptom was assessed twice 2 months apart.
Results: Hierarchical regression analysis revealed that
FA (FA=.16) and NBW (FA=.16) longitudinally predicted
time 2 symptom significantly (p<.01), even after partialling
out time 1 symptom. In addition, two PWB subscales
moderated the effects of negative appraisal for internal
state on GAD symptom (Purpose of Life x FA, p<.01;
Autonomy dimension x NBW, p<.05).
Conclusion: Vulnerability factors have longitudinal
effects on GAD symptom. In addition, PWB have
longitudinal buffering effects on the link between cognitive
vulnerabilities and symptom. These results provide
additional supports to the clinical utility of WBT in terms
of primary prevention of GAD.
EABCT 2012
223
25
PA 25-03
Papers
PA 25-02
Papers
25
PA 25-04
PA 25 - 05
Cognitive predictive factors of Repetitive
Negative Thought across emotional disorder: A
transdiagnostic examination
Akbari Mehdi1; Rasool Roshan1; Steven Hayes2
1
Shahed University of Iran, Iran; 2University of Nevada,
USA
Effects of compassion focused therapy on
self-compassion, anxiety and depression in
university students
Kohki Arimitsu1
1
Komazawa University, Tokyo, Japan
Introduction: Compassionate Focused Therapy (CFT)
is a comprehensive treatment developed for selfcritical thoughts, which play a key role in many types of
psychopathology. The positive effects of CFT have been
reported in several studies, but only a few of these have
used a control group.
Objectives and Method: A treatment program based on
CFT was developed and its effectiveness in decreasing selfcritical thoughts, anxiety, and depression was evaluated.
The CFT treatment program was carried out in seven,
once weekly sessions. The program included compassion
meditation, mindfulness training, compassionate mind
training using imagery, compassionate letter writing, three
chairs work, and compassionate behavior. Participants
with low self-compassion were recruited in university
psychology classes, and randomly assigned to either
the treatment (N=14), or the control (N=17) groups.
Therapeutic outcome was measured using the SelfCompassion Scale, the Rosenberg Self-Esteem Scale, the
Beck Depression Inventory, the Spielberger Trait Anxiety
Inventory, the Depression Anxiety Cognition Scale and
the Multiple Mood Scale. All outcome measures were
conducted at pre- and post-treatment, and at three, and six
month follow-up.
Results: The CFT treatment group showed significantly
higher self-compassion and self-esteem, and lower selfcritical thoughts, trait anxiety, shame, and depression.
Pre- to post-treatment within-group effect sizes on selfcompassion were 1.96 and .07 for the treatment and the
control groups, respectively. These effects were maintained
after six months.
Discussion and Conclusions: The results of this study
suggest that the CFT program decreased self-critical
thoughts, anxiety, and depression. The study also provides
evidence for the efficacy of CFT outside the USA and the
UK. It is suggested that future studies should be conducted
with patients with symptoms of anxiety and depression
using a larger sample size to confirm the conclusion.
The result of researches showed repetitive negative
thinking as a transdiagnostic process across emotional
disorders. Therefore purpose of the current study was
cognitive predictive factors of repetitive negative thought
across emotional disorder. The sample research included
427 undergraduate students of Tehran University, Sharif
and Shahed. All participants completed Repetitive Negative
Thought Questionnaire, Difficults in Emotional Regulation
Scale, Intolerance Uncertainty Scale, Multidimensional
Experiential Avoidance Questionnaire and Metacognitive
Questionnaire-30. The Stepwise regression analysis
showed that emotional dysregulation, intolerance
uncertainty, metacognitive beliefs and experiential
avoidance are predicted about 80 percent of repetitive
negative thought. The research findings can be concluded
that cognitive factors in the development and maintenance
of repetitive negative thoughts play an important role and
provided common pathology pathways for emotional
disorders.
224
EABCT 2012
Fatigue after Traumatic Brain Injury
Catia Beni1
1
Private practice, Geneva, Switzerland
Tiredness and general fatigue in patients with traumatic
brain injury (TBI) is three times higher than in the normal
population. On average, 55% of victims of TBI suffer from
this problem which continues several years after TBI.
It is important to understand and handle the problem of
fatigue because of the difficulties it can cause. Fatigue can
jeopardize a successful rehabilitation, complicate social
and professional reintegration, and increase behavioural
problems. It can also have an impact on relations and
social activities, as well as on family relationships, lower
quality of life and cause psychopathological difficulties. It
was shown that 50% of TBI patients stop their activities
to rest and 36.2% have naps three to seven times a week.
Employers, teachers, colleagues and even those close to
the patients, not knowing the after-effects associated with
TBI, often interpret this as a lack of motivation or laziness.
Talk about fatigue is important for two reasons. Firstly
to show at a theoretical level the current knowledge of
the impact of fatigue after TBI, and secondly to study a
case example of fatigue management. This treatment,
performed on the basis of strategies derived from cognitive
behavioural therapy, was made on a 53 year old woman,
victim of a TBI. Various traditional tools of cognitive
behavioural therapies were used to reduce the impact of
fatigue on daily living. Rapidly, this woman was able to go
back to work part – time and to assume her different life
roles. Quality of life improved, especially as she was able
to resume recreational and social activities.
The management required some adjustments because of
cognitive impairments of the patient, but it was a success.
Briefly, the cognitive limitations to the effectiveness of
therapy are discussed and ways to overcome them are
proposed.
EABCT 2012
Contextual behavioral skills training in group for
adults with Asperger syndrome – a pilot study
Johan Pahnke1; Johan Bjureberg1; Sven Bölte1; Jussi
Jokinen1;Tatja Hirvikoski1
1
Karolinska Hospital, Stockholm, Sweden
Introduction: Asperger syndrome (AS) is a
neurodevelopmental disorder characterized by difficulties
in social interaction, communication and behavioral
flexibility, and associated with high rates of co-morbidity
and decreased quality of life. Contextual behavioral
therapies such as acceptance and commitment therapy
(ACT) and dialectic behavior therapy (DBT), have shown
to be effective for complex and chronic conditions. In a
previous study an adapted treatment program in group,
based on a contextual behavioral approach, was evaluated
for adolescents with AS (Pahnke et al, ms in prep). The
current study aims at evaluating feasibility, treatment
acceptability, and efficacy of the same treatment program
for adults with AS.
Objectives and Methodology: Using an open trial
design, we performed a preliminary evaluation of
contextual behavioral skills training in adults with AS
(n=10; age range 25-65 years) in an outpatient psychiatric
context. In the 12-session skills training group, the
treatment components were social skills training; values
work; mindfulness and acceptance practice; behavior
analysis; and AS-related psychoeducation. Feasibility was
expressed as rate of treatment completion and session
attendance, respectively. Treatment acceptability and
efficacy were measured using self-rating scales.
Results: Nine out of ten participants completed the
treatment. The average participation attendance was eleven
out of twelve sessions. Overall treatment acceptability was
good. A series of repeated measures ANOVAs showed a
significant reduction in subjective stress and improvement
in quality of life (primary outcome measures) and
psychiatric co-morbidity.
Discussion and Conclusion: This pilot study indicated
good feasibility and treatment acceptability. The treatment
program can be an effective method to reduce stress and
co-morbid psychiatric symptoms, and increase quality of
life, in individuals with AS. We are currently conducting a
randomized controlled trial.
225
26
PA 26-01
PA 26-02
Papers
Paper Session 26 - Assessment and CBT for
people with somatic comorbidities
Papers
26
PA 26-03
PA 26-04
Links between family environment and
adjustment of children with asthma: The
moderating role of asthma severity and control
Silva Neuza1; Carla Crespo1; Maria Cristina Canavarro1
1
University of Coimbra, Portugal
Introduction: Asthma is associated with health related
quality of life (HrQoL) impairment and higher risk for
psychopathology in children. However, clinical variables
have revealed limited power on predicting children’s
adjustment, suggesting the occurrence of interaction effects
with psychosocial factors, namely family environment.
Objectives and Methodology: This study aimed at
examining: 1) adjustment outcomes (general and specific
HrQoL and psychopathological symptoms) on different
levels of asthma severity and control; and 2) the moderating
role of asthma severity and control on the associations
between family environment and adjustment. Participants
were 257 children, aged 8 to 18 (M=12.14; SD=2.54) with
diagnosis of asthma, who attended outpatient services in
3 public hospitals. Children assessed family cohesion and
conflict (FES), general and specific HrQoL (KIDSCREEN-10
and DISABKIDS-37) and psychopathological symptoms
(SDQ). Asthma severity and control were assessed by
physicians (GINA).
Results: Children with controlled asthma presented
better HrQoL and fewer psychopathological symptoms
than children with uncontrolled asthma. No significant
differences on adjustment were found between severity
levels. The positive links between family cohesion and
HrQoL (generic and specific) and the negative link
between cohesion and psychopathological symptoms
were moderated by asthma severity: stronger associations
were found for persistent asthma. Asthma control
moderated the negative link between family conflict and
specific HrQoL and the positive link between conflict and
psychopathological symptoms, with stronger associations
for uncontrolled asthma.
Discussion and Conclusion: In pediatric healthcare,
along with clinical management of asthma symptoms,
the inclusion of psychosocial interventions focused on
promoting family cohesion and conflict resolution skills
could contribute to children´s better adjustment to asthma,
particularly when persistent or uncontrolled.
Effectiveness of group cognitive behavioral
intervention on stress,anxiety and depression in
patients with coronary artery diseases
Sara Hashemi1; Ladan Fata2
1
Segal CBT center, Tehran, Iran; 2Tehran University of
Medical Sciences (TUMS), Iran
Objective: Today, heart diseases are considered as
serious dangers to health and human survival among the
top causes of death in many societies. Stress, anxiety and
depression are underlying ischemic heart diseases and
even sudden death
Methods: This research is an experimental one with pre
test- post test design and experimental and control groups
with randomly assigned 36 patients in experimental and
control groups. The present aims at testing the effect of
eight, 2-hour sessions of stress management training based
on cognitive behavioral techniques. Subjects were tested
at the beginning and at the end of the project with Beck
depression inventory primary care, Beck anxiety inventory
and depression, anxiety, stress scales. The sample included
36 male and female patients with coronary artery diseases
who were selected through (available method). The data
was analyses via covariance analysis test. Results: Study
findings showed that the subjects of experimental group
that were under the intervention (training) compared with
control group showed significantly better scores and test
effectiveness.
Discussion: There is a high correlation between
psychiatric disorders and cardiovascular diseases
controlly. The subjects were homogeneous in terms of
age, education and socio- economic status. They were
both males and females equally as well. Therefore it can
be concluded that various factors affecting the dependent
variables were highly controlled and therefore the observed
effect on the dependent variables could be the result of the
interference imposed, which is the «stress management
training».
Conclusion: The findings indicated that psychological
aspects of cordial patients should be taken to consider.
Finally the presence of a psychological within the treatment
team of cardiac patients is suggested on a critical factor
and recommended.
226
EABCT 2012
EABCT 2012
PA 27-01
RCT of an Internet-based CBT skills package for
carers of people with anorexia nervosa
Christopher Williams1; Michael Sharpe1; Alan Carson2;
Catriona Kent3; Jane Walker2; Jon Stone2; Jonathan
Smith4; Rod Duncan3; Gordon Murray2; Isabella Butcher2
1
University of Glasgow, United Kingdom; 2University of
Edinburgh, United Kingdom; 3NHS Greater Glasgow and
Clyde, United Kingdom; 4NHS Lothian, United Kingdom
Background: Carers often struggle to cope when trying
to support those they care for who experience Anorexia
nervosa (AN). Sometimes responses are helpful, but for
some can be unhelpful e.g. through high levels of overinvolvement and criticism [also known as expressed
emotion (EE)].
This study evaluated the efficacy of a novel web-based
systemic CBT intervention for carers of people with AN,
designed to reduce carer distress and teach skills in
offering effective support.
Method: Carers of people with AN (N=64) were randomly
allocated to either the web-intervention, Overcoming
Anorexia Online, with limited clinician supportive guidance
(by email or phone), or to ad-hoc usual support from the
UK patient and carer organization Beat. Carer outcomes
were assessed at post-treatment (4 months) and follow-up
(6 months).
Results: Compared with the control intervention, webbased treatment significantly reduced carers’ anxiety and
depression (primary outcome) at post-treatment, with a
similar trend in carers’ EE. Other secondary outcomes did
not favour the online intervention. Gains were maintained
at follow-up.
Conclusion: This is the first ever study to use an online
CBT program to successfully reduce carer distress and
improve carers’ ability to support the person with AN.
References:
1.Grover M, Williams C, Eisler I, Fairbairn P, McCloskey C, Smith
G, Treasure J, Schmidt U. (2010) An off-line pilot evaluation of a
web-based systemic cognitive-behavioural intervention for carers of
people with anorexia nervosa. Int J Eat Disord. Nov 15. DOI: 10.1002/
eat.20871
2.Grover, M., Naumann, U., Mohammad-Dar, L., Glennon, D.,
Ringwood, S. Eisler, I., Williams, C., Treasure, J., Schmidt, U.
(2011). A randomised controlled trial of an internet-based cognitivebehavioural skills package for carers of people with anorexia nervosa.
Psychological Medicine. doi:10.1017/S003329171100076
227
27
Efficacy of Cognitive Behavior Therapy on
psycho-social performance of chronic low back
pain patients
Neda Ali Beigi1; Fatemeh Razavi2; Mehdi Zare2
1
University of social welfare and rehabilitation sciences,
Tehran, Iran; 2Islamic Azad University, Iran
Introduction: Because of high prevalence of chronic
pain and its effects, finding an appropriate treatment can
helps patients to adopt with their pain, reduce disabilities,
increase self-sufficiency and psycho-social functioning
and minimize the effects of pain on their life.
Objective: Regarding to the impact of psychological,
social, and economic constraints due to chronic low back
pain, this study conducted to determine the effectiveness
of Cognitive- Behavior Therapy on pain intensity,
psychosocial functions, depression and anxiety of patients
with chronic low back pain in productivity age.
Methodology; It was a single case study. 6 female
patients who fulfilled the criteria for chronic low back
pain (CLBP) were assigned to CBT. 6patients completed
a standardized battery of questionnaires, including a
measure of chronic pain intensity, Moris and Roland
pain disability, psycho-social rating scale, BDI-II and
BAI. Assessments were performed pre-treatment and
post-treatment as well as 1and 6 months post-treatment.
Treatment lasted approximately 11 weeks. The treatment
plan was on the basis of Otis manual which is printed by
oxford press as treatments that work series.
Results: Patients receiving CBT reported a significant
reduction in pain intensity post-treatment (F > 3.89, P < 0.01).
In addition, they reported statistically significant improvement
in disability and psycho social functioning (Fs > 3.95, Ps
< 0.01). There was no statistically significant difference in
depression and anxiety scores between two assessments
(p=0/2, 0/07).
The post-treatment effects for the CBT group were
maintained at both the 1- and 6-month follow-ups.
Discussion and Conclusion: These results suggest that
CBT is effective in treating patients with CLBP. CBT is an
active treatment which through implementation of it, we
can effectively help patients feel more in command of their
pain control and enable them to live as normal a life as
possible despite pain.
Paper Session 27 - Internet treatment for
differenT population
Papers
PA 26-05
Papers
27
PA 27-02
PA 27-03
Internet-Related psychosis: a new challenge for
CBT
Angela Ganci1
1
Istituto Beck, Roma, Italy
Introduction: Computer-mediated communication
(CMC) is an integral part of modern life, but the
adverse consequences secondary to excessive use are
underestimated.
Internet addiction disorder (IAD) has become an increasing
critical issue among adolescents, initially free of mental
health problems (Lawrence & Zi-Wen Peng, 2010).
Recent studies have suggested a likely connection
between unrestricted Internet use and the manifestation of
psychotic episodes, namely Internet mediated psychosis
(e.g. Heston, 2011).
Objectives: This study is aimed to deepen the current
researches on the effects of pathological Internet use on
brain and psychosis onset, and therapy effectiveness
Methodology: A bibliographic analysis is utilized,
through the examination of different outcome studies
Results, Discussion and conclusion: Internet
psychosis as a diagnostic condition is not yet well defined
enough for inclusion in the Diagnostic and Statistical
Manual of Mental Disorders.
However, many researches show that lack of social
cues during online networking may result in mistaken
perceptions and psychotic episodes.
Risk of psychosis has been found in blog use, as aberrant
over-reaction to comments or lack of comments by other
bloggers.
Few studies on brain structure in IAD subject have been
conducted, showing abnormalities in white matter and
corpus callosum integrity, probably linked to some
behavioral impairments.
The relation with psychotic episodes emergence has been
proposed, as well as white matter integrity as a potential
new treatment goal.
Current treatments for pathological internet use include
behavioral strategies as abstinence, cognitive therapy,
useful to recognize negative cognitions as to develop new
adaptive ones, family therapy and support groups.
Prevention
remains
the
key
strategy:
psychoeducational approach help people learn about
Internet limitations in interpersonal communications and
develop realistic expectations when engaging in social
communications online.
Internet-based relapse prevention for partially
remitted depression. Two-year outcome of a
randomised trial
Fredrik Holländare1; Susanne Johnsson1; Mia Randestad1;
Maria Tillfors1; Per Carlbring2; Gerhard Andersson3;
Ingemar Engström1
1
Örebro University, Sweden; 2Umeå University, Sweden;
2
Linköping University, Sweden
Introduction: Although several treatments are effective in
the acute treatment of major depression, long term effects
are discouraging. When full remission is not achieved
the risk of relapse is especially high. Cognitive behavior
therapy (CBT) is an effective form of relapse prevention,
however there is not enough therapists to meet the
demand. If Internet-based CBT has the same protective
effect it would be possible to offer relapse prevention to a
large number of patients.
Objective: The objective of the study was to investigate
the long term effects of Internet-based relapse prevention
for sufferers of partially remitted depression.
Methodology: Eighty-four persons with partially remitted
unipolar depression were randomised to either Internetbased cognitive behaviour therapy (iCBT) or to a control
group. After the ten week intervention period, participants
were followed for 24 months and diagnostic interviews
were conducted to establish relapses. The intervention,
and monthly self ratings of depressive symptoms, was
administered via an Internet-based platform that also
allowed for secure communication with all participants.
Results: Two years after the Internet-based intervention
significantly fewer participants in the iCBT group (5/32
or 15.6%) had experienced relapse compared to those
in the control group (23/35 or 65.7%). There was a nonsignificant trend towards a larger reduction in symptom
levels during the study in the intervention group compared
to the control group.
Discussion: iCBT did lower the relapse rate (compared
to the control condition), and the difference between the
groups increased during the 24 months of follow up.
Although the protective effect from iCBT was evident it is
unclear what role the treatment of the residual symptoms
played in the prevention of relapse.
Conclusion: Internet-based CBT (iCBT) seems
promising for preventing relapse into major depression,
at least until two years after the intervention.
228
EABCT 2012
PA 28-01
Cognitive therapy for bizarre and overinvested
obsessions and delusional-like beliefs
Kieron O’Connor1; Natalia Koszegi2
1
University of Montreal, Canada; 2Louis-H. Lafontaine
Hospital, Montreal, Canada
Introduction: This workshop presents a novel cognitive
approach, the inference-based therapy (IBT), to addressing
difficult-to-treat delusions and obsessions. The IBT
addresses the reasoning behind primary delusional and
obsessional beliefs, in particular the distrust of the senses
and overinvestment in remote possibilities.
Objectives: The aim of the workshop is to sensitize
participants to the IBT approach and describe the major
steps in its application.
Method: The first part of the workshop discusses: the
conceptual underpinning of the IBT and in particular its
grounding within reasoning theory; and how obsessions
and delusions entail ‘inferential confusion’ by mixing
up possible and real information. A second part covers
the development of clinical scales and questionnaire
measures of inferential confusion and empirical studies of
experimental reasoning paradigms showing the relevance
of inferential confusion to OCD symptomatology. The third
part of the workshop covers the application of IBT. IBT
conceptualizes obsessions and delusions as inferences
arrived at through prior reasoning which the steps of the
IBT program aim to progressively modify. The IBT program
is described step by step, passing through stages of:
identifying the primary inference, soliciting the background
reasoning narrative, unravelling the accompanying
reasoning processes, and modifying the inference by
replacing remote narratives with reality sensing. Case
examples will illustrate IBT case formulation.
Discussion and conclusion: There will be discussion
on how IBT complements current CBT which addresses
more downstream beliefs and behaviors following on from
the initial inference of doubt.
Reference. - O’Connor, K.P., Aardema, F. (2011) Clinician’s handbook
of OCD. Chichester: Wiley Bla
EABCT 2012
229
28
Computerized Cognitive Behavioral Therapy
(CCBT)
Dan Ophir1
1
Ariel University Center of Samaria, Israel
Cognitive behavioral therapy (CBT) is currently a very
popular method among the psychotherapists. Its main
advantage lays in its simplicity and in its schematic
methodology. These characteristics facilitate the creation
of a computer implemented cognitive therapy model.
The crux of this model is in finding the so called “distorted
thought”. Distorted thought is a thought which tries
to represent a reality, but instead gives an opposite or
unrealistic result. This is an example of distorted thought:
A student who has received a C, concludes “I am a
complete moron…”. Cognitive thoughts are formulized
by the human brain into a natural language, namely into
meaningful spoken or written sentences. Therefore, the
analysis of any thought is actually performed on sentences,
the thought’s linguistic counterpart.
The linguistic analysis is performed on two levels: the
semantic and the syntactic ones. In the semantic analysis
the vocabulary of the thoughts is checked. The distorted
thoughts’ text is characterized by the use of superlatives
such as “never”. The distorted thought is defined and
categorized by the CBT’s developers and thus may be
recognized and classified automatically by the computerized
analysis of the corresponding text. This analysis is based,
in the first iteration, on the corresponding usage of
expressions, called “distinguished” words. In order to find
these distinguished terms which indicate the possibility of
the cognitive distortion, quantitative semantics must be
introduced.
The next step is the syntactic sentence analysis leads to
syntactic sentence transformation from an affirmative
one to an interrogative one, guiding the user to self
improvement.
Paper Session 28 - OCD: Psychological
particularities and treatment
Papers
PA 27-04
PA 28-02
When it Gets Really Intrusive : The Experience of
OCD and Intervention From an ACT Perspective
Martin Brock1
1
Nottinghamshire NHS Healthcare Trust,
Nottingham, United Kingdom
Target Audience: Graduate students, researchers and
practitioners in the field of psychology, social work,
and mental health Obsessive Compulsive Disorder is
recognized as a complex disorder and is difficult to treat,
due in part to the intrusive nature of highly distressing
thoughts and sufferers’ strong motivation to abate, avoid
or eliminate them. Acceptance and Commitment Therapy
(ACT) is a behavioural treatment model that emphasizes
acceptance of internal experiences, while maintaining a
focus on positive behaviour change. This addresses the
maladaptive avoidance of internal experiences associated
with OCD, while also focusing on making and keeping
values-consistent commitments. This presentation will
describe the Functional Contextual model underlying ACT
for OCD; will provide experiential opportunities to develop
awareness of the typical experiences characteristic of
OCD; and will invite therapists to explore and share the
challenges of working with clients with OCD.
Papers
28
References:
Hayes, S.C, Strosahl, K.D., & Wilson, K.G. (2012). Acceptance and
commitment therapy: The process and practice of mindful change (2nd
edition). New York, NY: The Guilford Press
Purdon, C. (2004). Empirical investigations of thought suppression in
OCD. Journal of Behavior Therapy and Experimental Psychiatry, 35,
121–136.
Tolin, D. F. (2009). Alphabet soup: ERP, CT, and ACT for OCD.
Cognitive and Behavioral Practice, 16, 40-48.
PA 28-03
Replacing intrusive thoughts: Comparing high
and low OCD symptom groups
Ragnar Ólafsson1; Reynar Bjarnason2; Árni Kristjánsson2;
Ívar Snorrason3; Paul Emmelkamp4; Daníel Ólason2
1
University of Iceland & Landspítali-University Hospital,
Reykjavík, Iceland; 2University of Iceland, Reykjavík,
Iceland; 3University of Wisconsin-Milwaukee, USA;
4
University of Amsterdam, The Netherlands
Introduction: Impaired thought control is characteristic of
people with symptoms of Obsessive- Compulsive Disorder
(OCD). It has been pointed out (e.g. Clark, 2004; Purdon
et al., 2011) that thought replacement (i.e. removing
intrusive thought by replacing it with another more neutral
thought) may be a useful experimental paradigm to better
understand the nature of impaired though control in OCD.
230
Objectives: The objective of the present study was to
compare performance of university students that were
high or low in self-reported OCD symptoms, on a thought
replacement task where they had to form and then remove
a neutral, negative and personally intrusive thought by
replacing it with a neutral thought.
Methodology: Forty students at the University of
Iceland participated in the experiment (N=20 in high/
low groups). Participants filled in a number of OCD
related questionnaires and solved a computerised
thought replacement task where they had to form a target
thought (neutral vs. negative vs. personally intrusive) and
replace it with a neutral thought. Replacement time was
measured and participants answered questions regarding,
among other things, reoccurrences of the target thought,
emotional reactions and urge to avoid the target thought
and removal difficulty.
Results: Preliminary analyses show that, replacement
times were longer for negative and intrusive thoughts
than neutral thought. Negative and intrusive thoughts
reoccurred more frequently than neutral thought and
was higher in the high symptom group. High symptom
group reported also greater replacement difficulty, greater
emotional reactions and avoidance of the negative and
intrusive thoughts.
Discussion and Conclusion: Thought replacement may
be a useful experimental paradigm to investigate the nature
of impaired thought control in OCD. Participants with OCD
symptoms may have difficulty dis-attending from negative
thought material, that can result in more intrusions.
PA 28-04
Self-esteem, Perfectionism and Checking
Behaviors in OCD
Richard Ohring1
1
Netanya Academic College, Israel
Introduction: Low self-esteem has been associated with
and proposed as an etiological factor in OCD (Ehntholt,
Salkovskis, & Rimes, 1999). In addition, perfectionism
has been associated with OCD (Egan, Wade, & Shafran,
2011) and has been identified as one of six core cognitive
factors in OCD (Obsessive Compulsive Cognitions
Working Group, 1997).
Objectives and Methodology: The purpose of the
present study was to examine the relationship between
self-esteem, perfectionism, and checking behaviors in
a student sample, Eighty Two undergraduate students
were administered Rosenberg’s Self-esteem Scale (RSE;
Rosenberg, 1965), the perfectionism subscale of the
Obsessive Beliefs Questionnaire (OBQ; OCCWG; 2001)
and the checking subscale of the Obsessive Compulsive
Inventory-Revised (Foa et al., 2002).
EABCT 2012
Stimulus ambiguity promotes visual checking
in sub-clinical OCD: Data from an eye-tracking
paradigm
Marieke Toffolo1; Marcel van den Hout1; Ignace Hooge1
1
Utrecht University, The Netherlands
Introduction: Doubt is an important symptom in OCDpatients. Patients not only tend to have doubts regarding
their clinical uncertainties (e.g. “is the gas stove turned
off?”), but also display general doubt, for instance about
memory and perception. These uncertainties seem to be
fueled by ambiguity of events.
Objectives and Methodology: We developed an eyetracking paradigm to investigate whether people scoring
high (OC+, N=34), as opposed to people scoring low (OC-,
N=31), on OC tendencies display more general uncertainty
in relatively ambiguous situations, while using a behavioral
measure of uncertainty; checking behavior. Participants were
presented 50 visual search displays, and had to indicate
whether a target (closed circle) was present (“present”)
or not (“absent”). Half of the displays contained 24 open
circles and one closed circle (target present trials), and the
other half contained 25 open circles (target absent trials).
The target present trials were relatively unambiguous; the
response “present” could be based on the perception of the
target. Target absent trials were relatively ambiguous; for the
response “absent” participants had to rely on not having
overlooked the target.
Results: In target present trials there were no differences
between the groups. However, in all target absent trials
OC+ participants searched longer and used more eye
fixations, than OC- participants.
Discussion and conclusion: People with high OC
tendencies showed more general uncertainty, as reflected
in more visual checking, than people with low OC
tendencies, but only in ambiguous situations. Findings are
in line with research by Lazarov et al. (2012), who argue
that OCD-patients lack subjective conviction regarding
internal states, and therefore have to rely on external
proxies, such as rules or procedures. The eye-tracking
task seems a promising paradigm to investigate checking
behavior in OCD.
EABCT 2012
PA 29-01
Cognitive Flexibility in Mood Disorders
Camille Piguet1; Virginie Sterpenich1; Martin Desseilles2;
Yann Cojan1; Gilles Bertschy3; Patrik Vuilleumier1
1
University of Geneva, Switzerland; 2University of Liège,
Belgium; 3Strasbourg University Hospital, France
Introduction: Impairment in cognitive flexibility might
be one of the underlying processes in some symptoms of
mood disorders, such as crowded thoughts or ruminations.
Impaired ability to switch from one thought to another might
be correlated with specific changes in brain activity, and
extend to a general inability to switch from one emotional
state to another.
Method: We compared a group of mood disorders patients
(N= 29, MDD = 9, BP-I = 7, BP-II = 11, BP-III = 2) and
a group of matched healthy subjects (N=32) on a taskswitching paradigm involving happy and sad faces, that
allowed us to separate switching to a new task set and
inhibition of the previous set. We measured both Switch
Cost and Inhibition Cost as behavioural measures and
contrasted fMRI responses in these conditions.
Results: At the behavioural level, we found an interaction
between Switch Cost and Group (patients versus control
subjects): patients had a larger Switch Cost, especially for
the happy faces. At the neural level, a main effect between
patients and controls disclosed a hyperactivation of the
subgenual cingulate cortex in patients. The higher switch
cost was reflected in patients by a larger recruitment of
regions involved in switching, including left intraparietal
sulcus, left inferior fontal gyrus, right anterior cingulate.
Moreover, the subgenual cingulate region was also
differentially modulated by inhibition. It further correlated
with inhibition cost, with subjects showing a high inhibition
cost, and therefore good cognitive flexibility, being those
with larger deactivation in the subgenual cingulate in the
inhibition condition.
Conclusion: Our results show that patients have a larger
switch cost than control subjects, specifically with happy
faces, and this deficit in flexibility is associated with an
extended network recruited by switching in patients,
combined with impaired deactivation of subgenual
cingulated cortex.
231
29
PA 28-05
Paper Session 29 - Neuroscience and
Psychopathology 2
Papers
Results: Both self-esteem and perfectionism were
positively correlated with checking behaviors. In addition,
perfectionism partially mediated the association between
self-esteem and checking behaviors.
Discussion and Conclusion: The results offer further
support for the role of self-esteem and perfectionism in
OCD. It is suggested that perfectionism may be employed
as a coping strategy for low self-esteem, thus increasing
the risk for checking behaviors.
PA 29-02
Papers
29
Neuroimaging and cognitive behavioural
therapy: Mind to brain?
Joséphine Loftus1
1
Centre Hospitalier Princesse Grace, Monaco
Studies, in recent years, have explored the neurobiological
correlates of cognitive behavioural therapy (CBT). The
questions addresed in these studies is whether CBT
have an impact on neural circuits and if so, how does
this compare to pharmacotherapeutic related changes.
Objective: The aim of this paper is to review the results of
these studies; Methods: A literature search was performed
on the PubMed and PsyInfo databases. Keywords used
were ‘depression,’ ‘fMRI,’ ‘PET,’, ‘SPECT’, ‘panic disorder,’
obsessive compulsive disorder,’social phobia,’ ‘simple
phobia.’ Results: CBT was shown to modify neural activity.
The degree of regional activity could also predict response
to treatment. Social phobia, panic disorder and obsessive
compulsive disorder had similar patterns of modification
for both CBT and medication. Conclusion: CBT operates
at the level of the ‘mind’ and brain. Neuroimaging may
be useful in predicting response to therapy. Imaging
techiques increase understanding of the neurobiological
mechanisms of CBT and recent research suggests that they
may be successfully intergrated into therapeutic protocols.
PA 29-03
Impact of meditation expertise on pain
perception: a neuroimaging study
Antoine Lutz1
1
University of Wisconsin-Madison, USA
Experientially opening oneself to pain rather than avoiding
it is said to reduce the mind’s tendency toward avoidance or
anxiety which can further exacerbate the experience of pain.
This is a central feature of mindfulness-based therapies.
Little is known about the neural mechanisms of mindfulness
on pain. During a meditation practice similar to mindfulness,
functional magnetic resonance imaging was used in expert
meditators (> 10,000 h of practice) to dissociate neural
activation patterns associated with pain, its anticipation,
and habituation. Compared to novices, expert meditators
reported equal pain intensity, but less unpleasantness.
This difference was associated with enhanced activity in the
dorsal anterior insula (aI), and the anterior mid-cingulate
(aMCC) the so-called ‘salience network’, for experts during
pain. This enhanced activity during pain was associated
with reduced baseline activity before pain in these regions
and the amygdala for experts only. The reduced baseline
activation in left aI correlated with lifetime meditation
232
experience. This pattern of low baseline activity coupled
with high response in aIns and aMCC was associated with
enhanced neural habituation in amygdala and pain-related
regions before painful stimulation and in the pain-related
regions during painful stimulation. These findings suggest
that cultivating experiential openness down-regulates
anticipatory representation of aversive events, and increases
the recruitment of attentional resources during pain, which
is associated with faster neural habituation.
PA 29-04
Neural correlates of abnormal ‘guilt processing’
in patients with obsessive compulsive disorder
Barbara Basile1; Francesco Mancini1; Emiliano
Macaluso2; Marco Bozzali2
1
School of Cognitive Psychotherapy, Roma, Italy; 2Santa
Lucia Foundation, Roma, Italy
Guilt plays an important role in the occurrence and
maintenance of obsessive compulsive disorder (OCD).
Patients are particularly sensitive to deontological guilt
(DG), and not to other kinds of guilt, such as altruistic
guilt (AG). The aim of the current fMRI study is to assess
whether the role postulated for guilt in OCD is supported
by an abnormal processing of guilt, and more specifically
of DG. 13 patients with OCD and 19 healthy controls (HC)
were recruited. Psychological tools to assess/exclude OCD
symptoms and to quantify guilty feeling were administered.
Emotional paradigm is based on the presentation of specific
stimuli, selectively inducing DG, AG, anger and sadness
(as control conditions).Psychological tools confirmed the
diagnosis of OCD, also confirming patients’ higher attitude
in experiencing guilt. Consistently, behavioural fMRI
responses revealed that OCD felt more guilty in both guilt
conditions, compared to HC. fMRI results, showed that both
guilt conditions revealed decrease of activity in the anterior
cingulate cortex (ACC) of OCD patients, compared to HC.
When separately considering each type of guilt, patients
showed decreased activation in the ACC and the insula, for
DG, while no difference was observed in AG. Interestingly,
OCD patients activated more than controls in response to
both basic emotions. To sum, OCD patients reported more
guilty feelings on psychological assessments, as well
as during fMRI task performance. fMRI results suggest
that patients have reduced activation in the ACC when
experiencing guilt, regardless of its specific type (DG or
AG). As guilt is a more cognitively structured emotion, we
suggest a release of inhibition of this area on more basic
emotion circuits. Consistently an abnormal processing of
DG, but not of AG, was distinctive of OCD. Our findings
suggest that OCD might depend on the release of inhibition
on neuronal circuits subserving a specific complex emotion
(such as DG) patients’ are more vulnerable to.
EABCT 2012
EABCT 2012
PA 30-01
The bidirectional relationship between child
anxiety and parenting in clinical and control
children aged 4-12 years
Cathy van der Sluis1; Francisca van Steensel1; Susan
Bögels1
1
University of Amsterdam, The Netherlands
Introduction: Many studies have provided evidence
for a bidirectional relation between parenting and child
anxiety. Less is known about this relationship for younger
children (4-7 years), and if this relationship differs from
that of older children (8-12 years).
Objectives and Methodology: The aim of this study
was to investigate the bidirectional relationship between
child anxiety and parenting by examining (1) which factors
predict parenting (child age, child gender, child anxiety/
internalizing problems); and (2) which factors predict
child internalizing problems (child age, child gender, and
parenting behavior). Additionally, differences between
mothers and fathers were examined. In total 194 children
and their parents participated. Children consisted of 52
referred clinically anxious children, and 142 children
from the general population. Child anxiety, parenting, and
internalizing problems were assessed with the ADIS-P,
CDQ, and CBCL, respectively.
Results: Preliminary results showed that parents used
less positive reinforcement and less coercion for older
compared to younger children. Child anxiety/internalizing
problems lead to more use of positive reinforcement and
punishment by parents. Parenting practices were found to
predict child internalizing problems. More specifically, the
use of more punishment, and less coercion and modeling
by parents lead to more internalizing problems in children.
No significant differences were found between mothers and
fathers, or between boys and girls.
Discussion and Conclusion: Preliminary results
support a bidirectional relation between parenting and
anxiety/internalizing problems. However, it seems that
child anxiety/internalizing problems provokes specific
parenting practices, and that specific parenting practices
lead to more child internalizing problems. In addition,
child age is an important predictor in parenting practices.
233
30
CNS Sensitisation Disorder : Its Role in Fatigue,
Pain and Mood Disorder. Its Clinical Alleviation
with a Multi-Model Approach
Lesley Parkinson1; Ann McCafferty1
1
Brainhealth, The Diagnostic Clinic, London, United
Kingdom
This paper will outline the Central Nervous System
involvement in both Fatigue Disorders and Chronic Pain.
The areas and neurological pathways of dysfunction in
these conditions will be described. The model will also
demonstrate how the CNS dysfunction leads to mood
disorder. Whiplash injury is frequently involved and the
negative effects of exercise in these client groups will be
demonstrated.
A pilot research study will be described involving the
use of Neurological based Massage Therapy. Amplitudes
of brainwave activity pre and post treatment will be
presented.
Paper Session 30 - Parenting style and
psychopathology
Papers
PA 29-05
Papers
30
PA 30-02
PA 30-03
Perceptions of family environment and
adjustment of children and parents: A
transactional study in pediatric asthma
Silva Neuza1; Carla Crespo1; Maria Cristina Canavarro1
1
University of Coimbra, Portugal
Introduction: The particular challenges posed by
paediatric asthma may have a negative impact on
psychological adjustment of children and other family
members. From a transactional approach it is important
to examine how reciprocal influences between children
and their parents contribute to explain their psychological
adjustment.
Objectives and Methodology: This study aimed at
examining the links between children’s and parents’
perceptions of family environment and adjustment,
separately (within-subjects) and across participants
(cross-lagged effects). The sample included 257 children
with asthma, aged 8 to 18 (M= 12.14; SD= 2.54), and
one of their parents, recruited in three Portuguese public
hospitals. Family environment was assessed by both family
members as a latent variable composed of cohesion and
expressiveness subscales of FES; children’s adjustment
comprised self-reports of generic and specific health
related quality of life (KIDSCREEN-10 and DISABKIDS-37,
respectively) and psychopathological symptoms (SDQ);
parents’ adjustment included quality of life (EUROHISQOL-8), distress and wellbeing (MHI-5).
Results: Structural Equation Modelling was used to test
within-subjects and cross-lagged paths between children’s
and parents’ family environment and adjustment. The
model presented a very good fit (ƒÔ2= 37.32; p= .17; CFI=
.99; RMSEA= .03) and explained 45% of children’s and
26% of parents’ adjustment. More positive perceptions
of family environment were linked to better adjustment
for children (ƒÀ= .62; p< .01) and parents (ƒÀ= .43; p<
.01), independently. Regarding cross-lagged paths,
children’s family environment was positively linked with
parents’ adjustment (ƒÀ= .13, p< .04) and parents’ family
environment with children’s adjustment (ƒÀ= .09, p< .04).
Discussion and Conclusion: Perceptions of family
environment are important targets for interventions aiming
the improvement of children’s and parents’ psychological
adjustment in the context of paediatric asthma.
Does spending time with parents reduce juvenile
psychopathological symptoms?
Anne Milek1; Raquel Paz1; Claudia Eugster1; Martina
Zemp1; Guy Bodenmann1
1
University of Zurich, Switzerland
Shared family activities and routines provide a learning
environment for children in which tacit knowledge
of communicating, interacting and organizing one’s
experiences can be acquired. Thus, the amount of time
parents spend together with their children is considered
to be critically important for a variety of desirable
developmental child outcomes, mainly also from an
attachment theory point of view. Having time with and
for the child may also covary with more secure child
attachment when the time passed together is further
characterized by mother’s sensitivity.
However, little is known about the impact of shared family
time on child development. Do children, especially
those who suffer from a chronic disease (chronic
stressor) and therefore have a higher risk of developing
psychopathological symptoms, benefit from (more)
parental time?
The present study addresses this question by examining
to which extent the amount of time parents spend together
with their children pursuing different activities (having
meals together, making trips, watching TV together, etc.) is
associated with psychopathological symptoms.
Parents of children with a chronic disease (N=80) and
parents of a control group (N=100) were asked to report
how much time (quantity) they spend with their children
engaging in different activities (quality). Additionally,
parents completed the Strengths and Difficulties
Questionnaire (SDQ, Goodman 1997), which assesses
prosocial behavior and psychopathology of 3–16-yearolds.
Preliminary findings show significant associations
between juvenile psychopathological symptoms
(emotional, conduct and peer problems) and quantitative
as well as different qualitative time measures.
Spending time with parents can have a protective function
against the risk of developing psychopathological
symptoms for all children. Particularly children of a high
risk group might benefit from more shared time. Practical
implications for child therapy are discussed.
234
EABCT 2012
The attachment to parents and to peers in
patients with diabetes mellitus
Ana Matos1; Mariana Lima1; Telmo Leandro1
1
University of Coimbra, Portugal
Diabetes Mellitus is a chronic disease that results from the
insufficiency or not production of insulin by the organism.
Constitutes itself an emerging concern and deserves the
interest of investigation, to understand better its causes,
but also the consequences which may arise for patient’s
life.
In the present investigation, there took place a comparative
study of two groups (a clinical group and a control group
of the general population), relatively to the parents and
peers attachment. On the other hand, in the clinical group,
the importance of attachment in therapeutic adherence
levels was analysed.
The sample was constituted by 46 subjects with Diabetes
Mellitus and 46 subjects of the control group, with ages
between 14 and 25 years. The instruments used were the
Inventory of Parent and Peer Attachment (IPPA; Armsdren
& Greenberg, 1987; translated and adapted for the
Portuguese population by Neves, Soares, & Silva, 1999)
and Treatment Adherence Scale (Escala de Adesão ao
Tratamento; EAT, Matos, 1999).
The results indicate that there were no statistically
significant differences between the clinical and control
groups, relatively to attachment to mother, father and
peers. In the clinical group, a positive and significant
correlation between the attachment to mother and the
therapeutic adherence levels reported by the subjects
was found. However, the correlations between the
attachment to father and peers and adherence to treatment
weren’t significant. As clinical implications, it should be
emphasized the importance of attachment in the course of
disease. In the treatment of youth with Diabetes we must
identify dysfunctional attachments, specially to mothers,
and, consequently, initiate an intervention process when
needed.
Mother’s communication about interparental
conflict and children’s attention performance
after couple conflict exposure
Martina Zemp1
1
University of Zurich, Switzerland
Introduction: Attention problems, often manifested in the
clinical form of ADD/ADHD, are a frequent phenomenon
in many children and adolescents. Since ADD/ADHD
has one of the highest average heritability for psychiatric
disorders, researchers and clinicians repeatedly stress
the neurobiological and genetic aspects of etiology. In
contrast, the current body of research on environmental
factors that increase child’s vulnerability to ADD/ADHD
seems less ample. Increasing evidence suggests an
association between exposure to interparental conflict
and attention problems in children and adolescents. This
study examined with an experimental approach whether
exposure to a videotaped couple conflict decreases child’s
short-term attention capacity.
Methods: Participants were 60 children, aged 11-13
years, and their mothers. Children’s attention after having
watched 1-min videotaped sequence was measured in two
experimental conditions: (1) couple conflict condition, (2)
action film condition.
Results: Results indicate that couple conflict was at least
equally cognitively disturbing as the highly arousing
action sequence. Furthermore, children whose mothers
often provide supportive explanations on interparental
conflicts seemed more protected from impairments in their
attention performance.
Conclusion: This study emphasizes conflict
communication of parents to be a possibly powerful
trigger of attention problems in children and adolescents
and it supports the evidence that mother’s supportive postconflict communication is an important protective factor in
buffering adverse effects. This is highly relevant given the
severe consequences of attention problems for children’s
subsequent psychological and educational development.
Prevention and intervention programs should therefore
not focus exclusively on parents’ child-rearing abilities
but apply on constructive conflict tactics as well. These
and further results will be discussed with regard to ADD/
ADHD.
EABCT 2012
235
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PA 30 - 05
Papers
PA 30-04
Paper Session 31 - Professional issues and
CBT for employees
PA 31-01
Papers
31
Working with CBT in reducing barriers towards
employment in complex cases
Ola Kneppe1; Ulla Wattar1; Lærke Bogh1
1
The Wattar Group, Copenhagen, Denmark
Introduction: The IAPT programme in the UK is an
attempt to address both the unmet mental health needs and
the economic costs of people with untreated psychological
problems. In 2009, new legislation was introduced in
Denmark making psychological problems comparable
to physical handicaps. A person with psychological
problems that constitute a barrier to employment could
now be referred for treatment, a practice that until then,
had been exclusively existing for persons with physical
handicaps. The Wattar Group, a private CBT psychology
centre was granted the right to implement this effort. The
programme shares the same fundamental rationale as the
IAPT, but targets a population potentially more deprived.
Objectives and Methodology: The present study is
a pilot study on 80 consecutive clients having finished
their participation in the programme during the period
01.10.2011-20.01.2012. Of particular interest is 1)
whether the clients psychological barriers towards work
decrease, and 2) whether the symptom reduction seems
accompanied by work progression.
Results: Results indicate significant decreases in scores
on 1) BDI, t(61)=3,74, p=,000, 2), BAI, t(60)=3,02, p=,004
and a scale measuring the clients judgement of their own
progression towards work, t(46)=2,25, p=,030. 23 of the
clients (28.75%) were placed in the category “progression
towards work”. Results from a chi-square test showed no
significant differences between people having been on
longer and shorter than 15 years on welfare.
Discussion: The results showed the clients placed in the
“progression towards work” category benefitted more from
the program on all scales. There was evidence of a trend
toward clients with below basic level education benefitting
less from the program.
Conclusion: The program seems to have a broad effect on
its population, both concerning symptom reduction and
progression towards work. Its future development should
focus on how to help the most poorly educated clients.
236
PA 31-02
The Prescriptive Index for cognitive-behavioral
coaching: A new screening package for
organizations
Oana Gavita1; Arthur Freeman2
1
Babes-Bolyai University, Cluj-Napoca, Romania;
2
Midwestern University, USA
The Prescriptive Index is a new electronic platform
designed for cognitive-behavioral diagnosis, based on
a complex screening package of tools. The aim of the
present paper is to present both the development of the
Prescriptive Index platform and the tools comprised, and
preliminary psychometric properties of the measures. The
tools included in the platform are designed in order to be
able to measure all the essential components needed for
a comprehensive prescription for cognitive-behavioral
coaching both for employees and executives. Mood is
measured with the Binary Affective Profile Wheel, which is
based on the binary model of emotions (David, Montgomery,
Macavei, & Bovbjerg, 2005), and theoretically derived from
a dimensional structure of the semantic space displayed in
the form of an emotion circumplex (Russell, 1983; Scherer,
2005). Cognitions are measured using the EmployeeRational and Irrational Beliefs Scale and the ManagerRational and Irrational Beliefs Scale, tools developed for
measuring both the irrational and rational processes and
contents specific for organizations. Coaching skills of the
managers are measured using the Coaching Skills Grid
as self-report, other-report and observational grid. The
Prescriptive Executive Coaching (PEC) assessment is a
new multi-rater measure of managerial skills relevant for
executive coaching (Freeman & DeWolf, 1990), examining
interrelations between thoughts, emotions, environment,
Behaviours and culture, and determining the perceived and
expressed areas of concern in the form of a Prescritpive
Profile for PEC. Psychometric properties of the measures
are presented together with their applications for cognitivebehavioral coaching.
EABCT 2012
Looking for a job? How cognitive and behavioural
approach, mindefulness and positive psychology
improve candidates chances to find new work and
fufillement
Marion Aufseesser1
1
Private Practice, Geneva, Switzerland
Introduction: Job loss is a top stress factor in most
European countries with up to 25 % unemployment calling
for state of the art methods to accompany jobseekers. Job
seekers are at a high risk of developing mental health
problems. These need to be prevented. Taking care of job
seekers health makes sense from a public health point of
view.
Objective: Empower jobseekers to focus in a positive,
pro-active, mindful and realistic way on their career
transition process. Foster : self-confidence, self-esteem
and energy all essential when looking for a job.
Methodology: Approach based on cognitive and
behavioural coaching, mindfulness and positive
psychology, Anthony Grant’s work (Universtiy of NSW,
Australia; HIRES report (2009) and our publication “
Chômage et transition de carrière”, published in “Des
metiers pour aider”, Georg, 2010 amongst others.
Results: We will present Individual and Group Case
studies taken from our practice in national and international
situations outlining how the approach enhances the career
transition process. The method has been used for over 15
years with several hundreds of people.
Discussion For the job seeker: The approach improves
candidates’ job outlook. The approach has a positive
impact on candidates health. For the professional : Trained
psychologists working with job seekers can enhance their
mood. This in turn will have a positive effect on their
attitude towards their job search and improve their search
performance.
Conclusion: The approach positively impacts jobseekers
search skills and rates. The approach opens new job
perspectives for psychologists trained in the areas of
cognitive and behavioural coaching, mindfulness and
positive psychology. The preventive work is highly
rewarding and satisfying both for the job seekers as well
as for the professionals.
Prediction of job burnout based on alexithymia
and religion orientation, body symptoms and
demographic characteristics in a sample of
Iranian prison staffs
Shima Tamannaee Far1; Saeedeh Zenoozian1; Forugh
Esrafilian1
1
Tehran Medical University, Iran
Introduction: the purpose of this study is to investigate
of some potential predictors of job burnout base on
alexithymia and religion orientation, body symptoms and
demographic characteristics.
Method: to do so, 114 Iranian prison staffs were asked
to complete Toronto alexithymia scale(FTAS-20), extrinsic
and intrinsic religion scale, body symptoms scale and
Maslach burnout inventory(MBI).
Results: data showed positive significant correlation
between alexithymia and emotional exhaustion(EE) in job
burnout, body symptoms and FTAS, body symptoms and
EE. On the contrast, the intrinsic religion had negative
correlation with mental exhaustion and EE in job burnout.
regression analysis suggested a predictive model for
job burnout (EE) including years of working (B=2/787,
P<0/05), body symptoms(B=0/377, P<0/05), alexithymia
(B=0/385, P<0/01), but mental exhaustion is explained
by intrinsic religion(B=-0/217, P<0/05)and alexithymia
(B=0/143, P<0/01).
Conclusion: it can be concluded that alexithymia, body
symptoms, intrinsic religion, years of working have
significant correlation with job burnout. Due to importance
of these factors, it will be useful to improve interventions
which consider these issues.
EABCT 2012
237
31
PA 31 - 04
Papers
PA 31 - 03
PA 31 - 05
Papers
32
Developing a CBT manual for adult inpatient
secure services: Exploring patients’ and mental
health practitioners’ views on CBT for psychosis
in secure services
Gurmit Dhillon1,2; David Kingdon1; Mary Gobbi1,2
1
University of Southampton, United Kingdom; 2Central
and Northwest London NHS Trust, United Kingdom
Introduction: Patients remanded to forensic secure
hospitals often experience high levels of psychotic
symptoms and the realization of their legal situation
may worsen their condition. It is necessary to have an
understanding of what patients themselves view as being
effective within their treatment. This paper generates
new understandings of the perspective of patients and
mental health practitioners regarding the place of CBT
in secure services. It highlights key themes with clinical
implications to inform the development of a customized
CBT manual for this patient group.
Method: This qualitative research study used semi
structured interviews with 17 patients across 3 secure
settings. Focus groups were conducted in 3 secure
setting sites involving 25 health care practitioners. The
analysis employed a grounded theory approach (Strauss
& Corbin, 1990) with integration of thematic analysis.
First, the emergent themes were analysed according to
the participants (professionals and patients). Second the
participants themes were then compared with each to
elicit areas of commonality and difference.
Results/outcome: The analysis produced 14 themes
from both participants groups which were clustered into
two higher orders concepts. Professionals spoke about
their experiences of employing a multimodal approach
and essential components in CBTp. Their data identified
the important concepts of a ‘multimodal approach
and solution focused therapy’. Patients narrated their
experiences of living in secure services and ‘what works’
in therapy. Patient analysis revealed the importance of a
‘place of healing’ and the issue of ‘containment’.
Discussion/ conclusions: This study highlights those
concepts that are jointly experienced, albeit from different
perspectives, by both practitioners and patients. It clearly
identifies those issues that patients and professionals
find useful and other non specific aspects that influence
therapy process.
238
Paper Session 32 - Anxiety and Depression:
Assessment and treatment
PA 32-01
A new intervention: Guided self-help to
overcome anxiety
Christine van Boeijen1
1
GGNet, Apeldoorn, The Netherlands
For patients with anxiety disorders few treatments are
feasible in primary care. A literature review of self-help
shows sufficient effectiveness. The results improve when
guidance is added to keep the patient in the self-help
program. Subsequently a guided self-help is developed.
A preliminary study found that application of the guided
self-help was feasible and led to improvement in treated
primary care patients. A RCT following these findings
made a comparison of the effectiveness and feasibility
of the guided self-help, the guidelines and cognitive
behaviour therapy ‘golden standard’. There was no
difference in outcome between the three interventions in
the treatment period of 12 weeks. This effect lasted during
the follow up at 3 and 9 months. The feasibility of guided
self-help was greater than the guidelines. Guided self-help
is now implemented in preventive, primary and secondary
care. An online version of this intervention is on the way.
The self-help manual comprises an introduction,
information about anxiety, cognitive techniques, relaxation
exercises and exposure in vivo. The goal of the treatment to
overcome anxiety in 12 weeks is described. Each chapter
ends with self-control questions. The patient is advised
not to carry out the treatment alone, but with the help of a
friend or relative. In addition a cd with relaxation training,
a registration addition, an exercise addition, a flyer for
‘the helper’ and answers to the self-control questions are
available.
This self-help manual was discussed with the patient in 5
sessions in the course of 12 weeks. The guidance consists
of explanation about the self-help, answering questions,
discussing the compliance and motivation to take enough
time to practice and do homework.
This in-congress workshop consists knowledge about
anxiety disorders, an explanation of the guided self-help,
exercise of the first session and exercise coaching the
patient through the manual.
EABCT 2012
STEPS: a low-intensity, multi-level, multipurpose service for common mental health
problems
Jim White1
NHS Glasgow, United Kingdom
STEPS primary care mental health team in south Glasgow
provides one of the most comprehensive matched-care
mental health services in Britain. Working in a deprived,
multi-cultural area, the service attempts to meet major
challenges in low-intensity work including eliminating
waiting lists to provide immediate help to the very large
numbers of people with common mental health problems;
improving outcomes, attendance and completion rates;
offering GPs alternatives to prescribing, designing
services that are relevant to the psychosocial and cultural
needs of our population; offering genuine choice; working
with other organisations, developing preventative/ early
intervention approaches; working with GPs to help
increase detection rates of, e.g. depression and trying to
reach the ‘hard to reach’ – those individuals who are not
‘psychologically-minded’, greatly motivated and who often
have significant social issues to deal with, i.e. the people
who, largely, do not feature in research trials. This takes
us from being a reactive service, i.e. waiting for people
to come to us, to a more assertive outreach/community
psychology approach. We aim to get the best out of limited
resources.
STEPS works at six levels: individual therapy; classes/
groups; single contacts; non-face-to-face approaches;
working with others and population-level work. CBT
therapy services include: the Advice Clinic; ‘Call-back’
(phone assessment); Stress Control (transdiagnostic)
‘evening class’ (routinely with 120 people in each class);
Mood Matters class, workshops, e.g. anger, self-esteem.
Community/population level work includes websites,
e.g. www.glasgowsteps.com; DVDs, booklets, working
with schools, training voluntary organisations, Celtic
football club, synergistic work with Triple P; GPs, e.g.
use of ‘StressPac’; awareness raising programmes, e.g.
programmes on national television. This talk will describe
the model and look at outcome data.
Frequency and severity negative automatic
thoughts in depressed patients?
Maryam Esfahani1
1
Tehran Psychiatric Institute, Iran
Mindfulness-based cognitive therapy (MBCT) is a
structured approach to short-term treatment that principle
is designed to prevent depression. Based on researches
the efficiency of this approach on patients in the active
phase of depression and treatment resistant depression
also has been proved. Although this approach does not do
direct interventions on the cognitive content, the research
question arise whether MBCT may be effective on the
severity and frequency of automatic negative thoughts?
The purpose of this study was to answer the same question.
Method: In a pilot project, 26 patients diagnosed with major
depressive disorder based on DSM-IV criteria and structured
clinical interview (SCID) in the 2 control and experimental
groups were tested. All of patients with negative automatic
thoughts questionnaire (ATQ) and the Beck Depression
Inventory (BDI) were evaluated. Then, a Mindfulness-based
cognitive therapy treatment protocol in the experimental
group was administered 2-hour in10 sessions. All patients
were evaluated in the last treatment session again with the
same tests. Also, only the experimental group was evaluated
as a follow-up examination 1 month later, again with the
same tools. Finally, data were evaluated by analysis of
variance and covariance.
Results: Results showed that the implementation of this
treatment on the experimental group, was effective on the
frequency of negative automatic thoughts (P <0/01) than
the control group and stability of these results still had to
follow up. But the efficacy of this kind of treatment was not
significant on the severity of negative automatic thoughts
(p<0/003).
Conclusion: It seems that the impacts of mindfulnessbased cognitive therapy on negative automatic thoughts
are only on the reduced frequency, and no significant
effect on the severity of these thoughts.
EABCT 2012
239
32
PA 32-03
Papers
PA 32-02
PA 32 - 05
Can the Components of Intolerance Uncertainty
Model predict worry across the anxiety
disorders?
Rasool Roshan1; Mehdi Akbari1; Zohreh Hashemi2
1
Shahed University of Iran, Tehran, Iran; 2Tabriz University
of Iran, Iran
Worry is a common, and potentially disabling, feature
among individuals with anxiety disorders. Purpose
of the current study was independent contributions of
intolerance of uncertainty, positive beliefs about worry,
negative problem orientation, and cognitive avoidance as
components of Intolerance Uncertainty Model (IUM) in the
prediction of anxiety disorders. Participants comprised 64
adults with DSM-IV anxiety disorders. All completed selfreport questionnaires that measured pathological worry,
intolerance of uncertainty, positive beliefs about worry,
cognitive avoidance and negative problem orientation The
Stepwise regression analysis showed that components of
an intolerance uncertainty model are predicted about 77
percent of worry across the anxiety disorders. The research
findings can be concluded that IUM can conceptualized
worry in anxiety disorders.
Exploring Compassion: Systematic review and
meta-analysis of the association between selfcompassion and psychopathology
Angus MacBeth1; Andrew Gumley2
1
NHS Grampian, Elgin, United Kingdom; 2University of
Glasgow, United Kingdom
Compassion has emerged as an important construct in
studies of mental health and psychological therapy. This
has implications for enhancing our understanding of
recovery and resilience. In the last 2 decades an increasing
number of studies have explored relationships between
compassion and different facets of psychopathology.
However, there is considerable heterogeneity between
studies in terms of sampling, demographic correlates and
outcomes. This paper presents a systematic review and
meta-analysis of this literature. The systematic search
identified 20 samples from 14 eligible studies, representing
a total sample of n=4007. All identified studies used the
Neff Self Compassion Scale (Neff 2003). Meta-analytic
techniques were used to explore associations between selfcompassion and psychopathology using random effects
analyses of Fisher’s Z correcting for attenuation arising
from scale reliability. We report findings for the overall
relationship between compassion and psychopathology.
In addition, we report findings for associations between
compassion and common psychological symptoms
(depression, anxiety and stress). Heterogeneity and
potential moderators of the association between
compassion and psychopathology will also be discussed.
The discussion will focus on future avenues for improving
the evidence base for compassion in psychopathology, and
consider implications for the development of intervention
models.
Papers
32
PA 32-04
240
EABCT 2012
‘Stress Control’ large group didactic therapy for
the common mental health problems
Jim White1
1
NHS Glasgow, United Kingdom
Introduction: ‘Stress Control’ is a six session didactic
CBT ‘evening class’ designed for large format – typically
between 100 and 200 people. It was designed to better
meet the needs of routine clinical work. The approach has,
as its basic premise, the goal of ‘turning individuals into
their own therapists’. It differs from most therapies in that
the role of the therapist becomes that of the teacher while
the patient becomes the student. There is no discussion of
personal problems on the course. It attempts to achieve the
best compromise between best practice and best. A range of
easily understood booklets accompany the course.
It is mainly used as a ‘complete’ therapy but can be used
alongside individual therapy, e.g. PTSD. It is used for the
treatment of a range of common mental health problems,
e.g. anxiety, depression, panic, insomnia. Spouses/partners
are encouraged to attend. It attempts to teach individuals to
understand their problems within both a psychological and
social context. It can be used as a preventative approach.
The course is free to the user and is part of a wider stepped
care primary care CBT service (‘STEPS’).
Results: The course is now used extensively across Britain
and Ireland. It is increasingly used in continental Europe
with plans to introduce it, this year, to Mexico, Malaysia and
China. The approach is clinically effective, highly efficient
and has been extensively tested. Results from controlled
trials, comparisons with individual therapy, follow-ups to
two years will be looked at alongside the role of empathy
and non-specific factors. Within the STEPS service, it is, by
far, the most popular choice of service-users (more so than
individual CBT)
Discussion: The talk will look at how the approach works
in practice within the National Health Service and how it fits
in with a matched-care approach.
EABCT 2012
Occupational Stressors and Gender Differences
Ana Maria Rossi1
1
International Stress Management Association, Porto
Alegre, Brasil
Objectives: To compare and contrast occupational stress
that may affect the psychosocial well-being of male and
female professionals who were randomly selected for the
study.
Methods: A sample of 800 professionals was selected
from four large nationwide organizations (industry,
health, finance, education) in two large cities in
Brazil. The subjects selected answered a two-folded
questionnaire: (1) question one listed 14 work situations
that may cause stress and asked respondents to identify
those situations that caused them the most stress on the
job. (2) a follow-up question asked them to rank those
they had identified based on the number of problems the
situations had caused in accomplishing their work in the
past month.
Results: The results indicate that there are some
differences between the perception of males and females
in terms of sources of occupational stress but there is a
general agreement on the most dysfunctional stressors
on the job.
Conclusions: Overall, the study suggests that males and
females experience similar occupational distress which in
turn limits their effectiveness in performing their jobs. It
extends the claim that occupational stress impacts on the
organizational member’s well-being as well as on their
performance at work.
References:
Rossi, A.M. (2006). Occupational Stressors ans Gender Differences.
In A.M. Rossi, P.L. Perrewé, & S.L. Sauter (Eds.). Stress and Qualty
of Working Life: Current Perspectives in Occupacional Health.
Greenwich: Information Age Publishing, 9-17.
Zappert, L.T., & Weinstein, H.M. (1985). Sex differences in the impact
of work on physical and psychological health. American Journal of
Psychiatry, 132(10), 1174-1178.
241
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PA 34-02
Papers
Paper Session 34 - Coping with stress and
evaluation of quality of life
Papers
34
PA 34 - 03
PA 34 - 04
Preventing the stress of dual earner couples
Corina Merz1
1
University of Zurich, Switzerland
The stress level of professional life is increasing constantly
and to multiple demands has to be answered day by
day. This increases the pressure on the relationship and
partners are more and more in charge of balancing out
work stress. For this reason, stress prevention programs
that include both the work and relationship sphere are
meaningful.
The effectiveness and the middle term effects of
three different intensive forms of the Couples Coping
Enhancement Training (CCET) versus a randomized control
group are tested on a large sample (N=160) of dual earner
couples. The effectiveness of the training has already been
proofed on several other samples (no dual earner couples)
and results showed an enhancement of dyadic coping and
communications skills. Furthermore, the burnout-risk of
employees has been reduced by the training.
This study is the first to analyze the interdependence of
work stress, burnout symptoms and dyadic coping within
dual earner couples. Results reveal interesting differences
between the different formats and their impact on skills
and relationship functioning. Their meaning for dual
earner couples compared to other couples as well as the
spill-over of work-to-family and family-to-work processes
is discussed.
Psychometric Evaluation of the McGill Quality of
Life Questionnaire
Parvaneh Mohammadkhani1
1
University of social welfare and rehabilitation sciences,
Tehran, Iran
The purposes of this study were to evaluate the psychometric
characteristics and perform a factor analysis of the McGill
Quality of Life Questionnaire (MQOL) in a sample of
recovered depressed participants. These participants were
assessed with the Structured Clinical Interview for DSMIV Disorders (SCID) to ensure that they had fully recovered
from their most recent episode of depression. They
completed a series of self-report measures, including the
McGill Quality of Life Questionnaire. Descriptive statistics
for the MQOL are presented, and confirmatory factor
analysis was used to assess the fit of the hypothesized factor
structure. Cronbach’s alpha coefficients were calculated
for the questionnaire and each subscale to examine the
internal reliability. Internal reliability was found to be high
for the overall questionnaire, as well as for each of the
subscales, as the coefficient alphas ranged between .58
(for the physical scale), to .88 (for the existential scale). It
is suggested that the MQOL can be employed as a tool in
research and practice with this population.
References:
Bodenmann, G. & Shantinath, S. D. (2004). The couples Coping
Enhancement Training (CCET): A new approach to prevention of
marital distress based upon stress and coping. Family Relations, 53,
477-484.
Schär, M., Bodenmann, G. & Klink, T. (2008). The efficacy of the
Couples Coping Enhancement Training (CCET) in the workplace.
Applied Psychology: Health and Well-Being, 57, 71-89.
242
EABCT 2012
Posters
Posters
P001
P002
Effects of Fixed-Role Therapy Promoting an
Objective Standpoint on Social Anxiety
Hitomi Abe1; Nedate Kaneo1
1
Waseda University, Japan
Voluntary and involuntary memory biases and
responsibility beliefs in obsessive-compulsive
prone individuals
Wassim Abou-Khalil1; Grazia Ceschi1
1
University of Geneva, Switzerland
Based on Salkovski’s cognitive model (Salkovski & al.,
2000), obsessive-compulsive symptoms (OCS) are
characterized by frequent intrusive thoughts and images
of past events that are highly appraised in term of personal
responsibility. Theoretically, this dysfunctional appraisal
leads to different cognitive biases, beside others in
memories processes. The current analogue study aims
to examine, in a nonclinical sample of 40 young adults,
the mediator effect of responsibility beliefs on involuntary
as well as voluntary memories of positive and negative
events.
In an incidental learning phase, participants are presented
with 40 sentences describing either a positive or a negative
event. The sentences are randomly presented in one out
of the two responsibility conditions: “high” (i.e., “I wish
that…”) versus “low” (i.e., “Somebody wishes that…”).
In the test phase, different memory tasks of the events are
presented: an involuntary memory task, a free recall task
and a recognition task.
Preliminary results indicate that, under the condition of
high responsibility, participants recognized more negative
than positive events and report more distress that under the
condition of low responsibility. Furthermore, participants
report frequent intrusive thoughts and images related
with previously presented negative events and mention
a subjective responsibility feeling while experiencing
these intrusions. As expected, memories scores and
responsibility jointly predict OCS severity.
The pathogenic role of memory biases for negative events
as a function of responsibility.
Introduction: Fixed-role therapy (FRT) is a psychological
intervention technique based on personal construct theory
(Kelly, 1955). Previous research suggests that promoting
individuals objective standpoint during the enactment in
FRT is related to effects of FRT (Abe, 2007). This study
examined effects of FRT promoting individuals objective
observation of themselves on social anxiety.
Method: Participants were 30 university students with
a high social anxiety tendency (12 male and 18 female
students; mean age 21.43[1.17]). They were assigned to
a Groundwork (GW) + FRT group (n=10) which joined
a training program in which individuals learned how to
observe themselves objectively during the enactment
before receiving FRT for two weeks, a FRT group (n=11)
which received a standard FRT for two weeks, or a control
group (n=9) which did not receive any intervention. Before
and after the intervention, all participants answered: the
Japanese version of the Liebowitz Social Anxiety Scale
(LSAS-J; Asakura et al., 2002); and the Private SelfConsciousness subscale of the Self-Consciousness Scale
(Sugawara, 1984) to evaluate the participants objective
observation of themselves.
Results: A two-way analysis of variance was performed
with the LSAS-J scores as the dependent variable and the
group and time as the independent variables. The LSAS-J
scores of the GW + FRT and FRT groups significantly
decreased after the intervention. Furthermore, after the
intervention, the GW + FRT group scored significantly
lower on the LSAS-J than the control group, and tended to
score significantly lower on the scale than the FRT group.
Conclusions: The findings suggest that understanding
ones thoughts and behaviors from an objective standpoint
during the enactment increases effects of FRT on
alleviating social anxiety. Therefore, it is important to
promote individuals objective observation of themselves
before conducting FRT.
244
EABCT 2012
P004
Why are psychological treatments prolonged in
anxiety disorders?
Mónica Bernaldo-de-Quirós1; Labrador Francisco1;
Ignacio Fernández-Arias1; Francisco Estupiñá1; Carmen
Blanco1; Laura Gómez1
1
Complutense University, Madrid, Spain
Projection of Depressive Attitudes Onto Others:
The Role of Personality
Shadi Beshai1; Keith Dobson1
1
University of Calgary, Canada
Introduction. Anxiety disorders are the problems for
which people demand the most psychological attention.
It is important for clinical psychology to be able to deliver
an efficacious, effective, and efficient response to this
demand.
Objectives and Methodology. The purpose of this
study was to identify variables that may explain a longer
duration of psychological treatments in anxiety disorders.
Data from 202 patients of University Clinic of Psychology
at the Complutense University of Madrid who had at least
one diagnosis of anxiety according to DMS-IV-TR criteria
and had successfully completed treatment, were analyzed.
Results. Number of intervention techniques and a primary
diagnostic of obsessive-compulsive disorder were the
factors which explained a longer duration of treatment.
Conclusion. The results indicate the importance of
identifying which techniques are more effective for each
problem or objective in order to reduce, as far as possible,
the extension of the treatment without decreasing its
effectivity.
EABCT 2012
According to the principles of attributive projection
(Holmes, 1968) and the false consensus bias (Ross, Green,
& House, 1977) people tend to think that other people
are similar to themselves. This tendency occurs in part
because people use available information to evaluate their
surrounding world and the people within it, and information
about the self is often one of the most accessible and
salient sources of information. A number of studies have
investigated this phenomenon with individuals who show
signs of depression. Such studies have generally yielded
mixed results, in part due to the use of weaker methods.
Using an improved methodology, this study examined the
false consensus bias with participants who showed signs
of depression. Students were recruited from the University
of Calgary (N = 197) and filled out a number of scales,
including a mood questionnaire (CES-D) to assess their
depressive status, as well as the Sociotropy-Autonomy
Scale (SAS) to asses their need for autonomy or social
approval. They then read a number of scenarios with
negative themes (e.g., failing in school) and were asked to
think of such scenarios as occurring to themselves or the
“average university student”. After reading the scenarios,
they were asked to answer a number of questions that were
adapted from the Dysfunctional Attitude Scale, and which
evaluated the extent to which either the participant or the
“average university student” would endorse such attitudes.
Results revealed an interaction between personality and
rating target (self and other), wherein students high on
sociotropy, as opposed to autonomy, failed to project
their negative attitudes onto others. The implications of
these results for the development and maintenance of
depression are discussed, and suggestions for further
research are provided.
245
Posters
P003
P005
P006
Development and Initial Validation of the Fear of
Guilt Scale
Brenda Chiang1; Christine Purdon1; Adam Radomsky2
1
University of Waterloo, Canada; 2Concordia University,
Montreal, Canada
Disgust and its domains across the anxiety
disorders
Paloma Chorot1; Rosa Valiente1; Bonifacio Sandin1;
Miguel Santed1; Olmedo Margarita1; Daniel Campagne1
1
Universidad Nacional de Educación a Distancia (UNED),
Madrid, Spain
Posters
Introduction: Although guilt has long been associated
with the onset and persistence of obsessive-compulsive
disorder (OCD), there is little evidence that individuals with
OCD are higher in trait or state guilt than other individuals.
Based on clinical anecdotal experience, we hypothesized
that people with OCD may not possess greater trait or state
guilt per se, but may fear the feeling of being culpable
for a negative outcome; that is, they may overvalue the
meaning and importance of guilt and fear feeling guilty.
This fear of guilt may be a central mechanism in the
persistence of compulsions, as the act is repeated until the
possibility of causing harm is perceived to have passed.
This is consistent with Mancini and Gangemi’s (2004)
observation that people with OCD do not fear a negative
outcome itself, but fear being held responsible for that
outcome. Fear of guilt in OCD is a novel concept and no
existing scales assess this construct. The 48-item Fear of
Guilt Scale (FOGS) was thus designed to measure fear of
guilt in OCD.
Method: Items reflecting three constructs (overvalued
importance and meaning of guilt, reactive response to
feeling guilty, and proactive behaviours to prevent or
minimize guilt) were generated by the second two authors
and rated on 7-point Likert scales, based on respondents’
level of agreement with each statement. In two studies,
undergraduate students completed the FOGS and selfreport measures of anxiety, depression, neuroticism, and
guilt (N=367, N=771).
Results: Analyses indicate that the FOGS comprises 2
subscales and has good internal consistency, convergent
validity, and discriminant validity. Regression analyses
suggest that scores on the FOGS account for a significant
amount of variance in OCD symptom severity, even after
controlling for anxiety, depression, neuroticism, and state
and trait guilt.
Discussion: We will address theoretical and clinical
implications of these findings.
The emotion of disgust has been involved in various
anxiety disorders, specifically in the etiology and
maintenance of specific phobias (in particular bloodinjury and small-animal phobias) and obsessivecompulsive disorder. However, there has yet to be a
comprehensive comparison of disgust domains cross the
anxiety disorder. A sample of participants with a diagnosis
of anxiety disorder, representing the six DSM-IV anxiety
disorders (i.e., specific phobias, social phobia, panic
disorder, generalized anxiety disorder, posttraumatic stress
disorder, and obsessive-compulsive disorder), completed
the Multidimensional Disgust Scale (MDS; see Sandin
et al.) and the Positive and Negative Affect Schedule
(PANAS; Watson et al., 1988; Sandin et al., 1999). The
MDS is a 30-item self-report measure that assesses a total
of five different dimensions of disgust, i.e., hygiene (body
products), moral, sexual, body transgression, and smallanimals. Multivariate analyses of variance showed that
MDS total scores associated with each anxiety disorder
were greater than those of the control group, with the
exception of posttraumatic stress disorder. Relative to
other diagnostic groups, specific phobia and obsessivecompulsive disorder were associated with greater levels of
disgust. In addition, these two disorders were particularly
related to elevated scores on the hygiene and smallanimals disgust subscales. The content of such subscales
of disgust imply possible transmission of contaminants
and disease, and they correspond to the “core disgust”
suggested by Rozin, Haidt and McCauley (2000). The
pattern of results remained when negative affectivity
was used as covariate (two main risk factors of anxiety
disorders). The subscale of sexual disgust was not able
to differentiate between individuals with anxiety disorders
and the control group, nor between the diagnostic groups.
The clinical implications of these findings are discussed.
246
EABCT 2012
P008
Relationship between social anxiety and
attributed trustworthiness
Ruth Cooper1; Oliver Doehrmann2
1
University of Cologne, Germany; 2Massachusetts
Institute of Technology, Cambridge, USA
Characteristics of autobiographical memories
and the development of PTSD and Depression
after recent trauma
Anne-Kristin Daues1; Anke Ehlers2; Jamie Griffith3; Birgit
Kleim1
1
University of Zurich, Switzerland; 2University of Oxford,
United Kingdom; 3Northwestern University, USA
It is assumed that the correct interpretation of emotional
facial expressions constitutes a core ability for effective
social actions. Thus, it has been repeatedly tested whether
socially anxious persons show an interpretational bias for
face stimuli. Results to date are heterogeneous, which may
be because most self-ratings consisted of attributes that
are less relevant for engaging in social interactions. We
therefore examined the relationship of social anxiety and
face ratings for perceived trustworthiness, a dimension
that more strongly implies approach or avoidance
behavior. Our aim was to directly evaluate the empirical
support for four response patterns found in previous
studies examining the relationship between social anxiety
and face ratings. Because classical testing strategies are
not applicable for the simultaneous evaluation of multiple
models, we employed a Bayesian analysis of informative
hypotheses.
Ninety-eight undergraduate students rated 198 artificial
face stimuli on attributed trustworthiness and intelligence,
the latter serving as control condition. Subsequently,
participants completed a battery of social anxiety
questionnaires. We then tested the fit of four response
patterns on our data.
An absence of negative biases of social anxiety on
trustworthiness judgments of facial expressions was
found to be three times more likely than assuming any
kind of negative bias in social anxiety. Similarly, this
independence model reached the best fit for intelligence
ratings, indicating that social anxiety does not have a
prominent influence as well.
The evaluation of faces on both socially relevant and
irrelevant dimensions does not differ much in social anxiety.
We conclude that deviant encoding and interpretational
processes of facial characteristics may only be a minor
aspect in the development and maintenance of social
anxiety disorder.
Introduction: Overgeneral Memory (OGM) predicts
posttraumatic stress disorder (PTSD) and depression after
recent trauma. OGM is classically assessed by a wordcuing-paradigm, the Autobiographical Memory Test (AMT;
J. M.C. Williams & K. Broadbent, 1986). Participants are
asked to recall specific memories in response to cue
words. The main focus has to date been on scoring the
resulting memories on specificity. Memory content has
largely been omitted.
Objectives and Methodology: Autobiographical
memory content may play a role for the development of
PTSD and depression after recent trauma, just as memory
specificity does. The present study scored autobiographical
memories derived from the AMT with regards to several
characteristics and their relationship to the development
of PTSD and depression. Assault survivors (n=203)
completed the AMT two weeks post-assault, as well
as structured clinical interviews. Clinical interviews
were conducted again at six months. Autobiographical
memories were coded for affective content, traumarelatedness, social context and autonomy.
Results: Preliminary analyses show a significant
relationship between memories’ positive affective tone,
specifically in response to negative cue words, and PTSD
and depression severity. In particular, the more negative
the recalled memories, the more PTSD-symptoms were
reported at two weeks, r=-.41, p=.04, and the more
depressive symptoms were reported at six month, r=-.44,
p=.03. Further analyses will be presented.
Discussion: Preliminary results indicate a relationship
between autobiographical memory content characteristics
and PTSD symptoms. Our results point to an important
predictive role of certain types of memories and later
development of psychopathology.
Conclusion: Assessing autobiographical memory content
may contribute to understanding mechanisms for the
development and maintenance of PTSD and depression.
Possible clinical implications are discussed.
EABCT 2012
247
Posters
P007
P009
P010
Training eye contact with the dot probe task: A
way to increase eye contact in socially anxious
individuals?
Evelien Dijk1; Mike Rinck1; Xijia Luo1; Anja Barth1; Becker
Eni1
1
Radboud University Nijmegen, The Netherlands
Evaluation of a Parent-Based Intervention to
Reduce Heavy Drinking in the Freshman Year of
College
Diana Doumas1
1
Boise State University, USA
Posters
Introduction: Research findings suggest that individuals
with social phobia avoid eye contact (e.g., Horley et al.,
2004; Schneier et al., 2011). Avoidance of eye contact is
regarded as a safety behavior that leads to a worsened
quality of social interactions and maintenance of fears
(Clark, 2001).
Objectives and Methodology: In a preliminary study,
the suitability of the dot probe task for increasing eye
contact was tested in an experiment with a pre- and postmeasurement of gaze duration towards the eyes, in an
unselected student sample (N=39). It was hypothesized
that attention training towards the eyes would (1) decrease
reaction times to probes that appear in the eye region and
increase reaction times to probes that appear in the chin
region during a dot probe assessment and (2) increase
gaze duration at the eyes and decrease gaze duration at
the chin during an eye tracking measurement. Attention
training towards the chin was expected to result in the
opposite patterns.
Results: Hypotheses concerning the eye tracking
measurement were confirmed, but hypotheses concerning
the dot probe assessment were not.
Conclusion: This study shows that gaze behavior can be
trained towards the eyes. A second study examines the
effect of attention training towards the eyes vs. towards the
area outside the face on behavior in a social interaction.
Clark, D. M. (2001). A cognitive perspective on social phobia. In W. R. Crozier &
L. E. Alden (Eds.), International handbook of social anxiety: concepts, research
and interventions relating to the self and shyness (pp. 405-430). Michigan:
Wiley.
Horley, K., Williams, L. M., Gonsalvez, C., & Gordon, E. (2004). Face to face:
Visual scanpath evidence for abnormal processing of facial expressions in social
phobia. Psychiatry Research, 127, 43-53.
Schneier, F. R., Rodebaugh, T. L., Blanco, C., Lewin, H., & Liebowitz, M.
R. (2011). Fear and avoidance of eye contact in social anxiety disorder.
Comprehensive Psychiatry, 52, 81-87.
Introduction: High-risk drinking and the negative
consequences associated with heavy alcohol use have
been well-documented on college campuses. Relative to
the general college student population, first year students
have been identified as a high-risk group for heavy
drinking. A growing body of research suggests that parent
based interventions (PBIs) are effective in reducing heavy
drinking in first year college students.
Objectives and Methodology: The purpose of this
study is to compare the effectiveness of PBIs with and
without booster brochures vs an assessment only control
group with first year students. Incoming first year students
(N=443) ages 18-20 were randomly assigned to one of
three groups: 1) PBI alone (PBI; n = 141), 2) PBI plus
booster brochures (PBI-B; n = 152), or 3) assessment
only control (CNT; n = 149). Participants completed
questionnaires on drinking variables at baseline and 4
month follow-up assessments. Parents of students in
both intervention groups received a parent handbook the
summer prior to fall semester. Parents in the PBI-B group
also received three booster brochures throughout the fall
semester.
Results: Sixty percent of the students completed the
4 month follow-up. There were no baseline drinking
differences between those who completed and those who
did not. Repeated measures ANOVAs were conducted
to assess changes in weekly drinking, frequency of
drinking to intoxication, and peak drinking quantity.
Results indicated lower levels of frequency of drinking to
intoxication and peak drinking quantity in the PBI-B group
relative to students in the PBI group and CNT group.
Discussion and Conclusion: Results of this study
provide support for the use of booster brochures in
combination with a parent handbook. Findings add to the
growing body of literature suggesting PBIs are a promising
strategy for reducing the growth of heavy drinking in first
year students.
248
EABCT 2012
P012
Motivational Effects on Attentional Control in
Arachnophobia
Martyn Gabel1; Daniel Smilek1; Grayden Solman1;
Christine Purdon1
1
University of Waterloo, Canada
Analysis of emotional and cognitive appraisals
and cardiovascular response induced by a BAT to
OCD contamination relevant stimulus
Gemma Garcia-Soriano1; Vicent Rosell1; Miguel Ángel
Serrano1; Sandra Simó1; Rufer Michael2; Aba Delsignore2;
Weidt Steffi2
1
Universitat De València, Spain; 2University Hospital of
Zürich, Switzerland
Introduction: The cognitive task of thought suppression
has been considered to have the ironic effect of increased
frequency of the thought that is trying to be suppressed;
however, motivation may play a key role in one’s ability
to efficiently suppress a given thought. In many phobias,
including arachnophobia, top-down attentional goals
such as thought suppression and visual avoidance might
be used as a short-term adaptive strategy to help reduce
situational anxiety. Conversely, attentional ambivalence,
defined here as a lack of strong motivation for attentional
deployment towards or away from threatening stimuli,
may lead to difficulty disengaging from threatening
stimuli and a subsequent increase in anxiety. Accordingly,
individuals high in attentional ambivalence may also have
higher overall distress or impairment than those low in
ambivalence. At present, however, no known studies
have empirically tested the hypothesis that attentional
ambivalence has a negative affect on arachnophobia.
Objectives and Methodology: In the current study,
individuals differing in degrees of spider