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Birmingham BABCP conference: first day - decentering, compassion, insomnia, social anxiety, sp/sr & barbecue (3rd post)

This is a quick overview of the first full day of the annual BABCP summer conference in Birmingham.  I intend to return to some of the key learning points in later posts.  I've already written about the pre-conference workshop I went to on "Emotion regulation" in a couple of earlier posts. Apparently the conference itself offers 37 symposia, 5 panel discussions, 3 clinical roundtables, multiple poster sessions, 13 skills classes, numerous special interest group & branch meetings, and 18 keynote addresses - all over the course of two and a half days here on the University of Birmingham campus. The freely downloadable 101 page abstracts book gives a great sense of what's on offer.

It regularly strikes me - when attending these big multi-track conferences - that it would be very possible to come with several colleagues and all end up going to totally different sets of presentations.  The conference is a buffet of choices and part of the challenge is to construct a personal "academic meal" that will really feed our own particular work & intellectual needs.  So yesterday the "meal" I put together involved dipping into a symposium on "Elucidating the mechanisms & moderators of meditation enriched treatments: At the confluence of CBT, affective science, and contemplative practice" before switching across to another on "The role of compassion in mental health".  I then went to a fine end-of-morning keynote on "The past, present and future of psychological therapy for insomnia disorder", glanced around some poster presentations, had lunch and went on to a great skills class on "Optimising video feedback for social anxiety disorder: Face-to-face and virtual techniques".  Finally I attended a keynote on "Why CBT therapists need to take a good look at themselves", briefly checked out the posters again, before chilling out and then wandering along to the conference barbecue.  Full day! 

So first, dipping into the symposium on "Elucidating the mechanisms & moderators of meditation enriched treatments".  I was interested to hear David Fresco - co-presenter at the pre-conference workshop I went to on "Emotional regulation" - talk about "Decentering from distress: Regulating negative emotion by increasing psychological distance."  His abstract states: "Decentering, which represents one’s ability to observe thoughts and feelings as temporary, objective events in the mind, as opposed to reflections of the self that are necessarily true, is present-focused and involves taking a nonjudgmental and accepting stance regarding thoughts and feelings. Although the concept of decentering can be found in traditional cognitive therapy (e.g., Beck et al., 1979), Teasdale and colleagues (2002, p. 276) suggest that it was primarily seen as “a means to the end of changing thought content rather than, as ... the primary mechanism of therapeutic change.” Increasingly, evidence has validated decentering as a construct important in the acute and enduring treatment of MDD and anxious depression (Fresco, Segal et al., 2007; Mennin & Fresco, 2011), GAD (Hoge, Bui, Goetter, Robinaugh, Ojserskis, Fresco, & Simon, 2013) and in the prevention of MDD relapse following prophylactic treatment with mindfulness based cognitive therapy (MBCT; Bieling et al., 2012). Given these promising findings, research has increasingly sought to elucidate the biobehavioral markers of decentering associated with its salutary benefits. In particular, this work has initially focused on decentering’s relationship to negative self-referential processing (Barron et al., 2013; Mennin & Fresco, 2013; Vago & Silbersweig, 2012). A recent study with fMRI assessment and neural correlates of treatment following MBCT revealed that decreased activation in the posterior cingulate cortex (PCC), a region associated with experiential and nonjudgmental self-reflection (Johnson et al., 2006) was associated with high self-report decentering and low relapse (Fresco, Shepherd, Farb, & Segal, 2013). Thus, despite these promising findings, study of decentering has largely been limited to self-report, and the mechanisms through which decentering alleviates and prevents the symptoms of depression remain unexplored.  As a first step to address this gap, we developed and began validating two objective decentering tasks of individuals’ ability to create psychological distance (i.e., decenter) in response to negative emotional provocation. Tasks manipulated psychological distance either implicitly or explicitly, and self-reported negative affect and arousal were collected as a function of increasing distance from distressing visual stimuli (e.g. images of poisonous insects or snakes). We examined associations between task performance, in terms of reductions in distress from distancing, and self-report measures of depressive and anxiety symptoms, trait mindfulness, and emotion regulation.  We found that implicitly increasing psychological distance from distressing visual stimuli reduced emotional reactivity to those images, but only in individuals with low levels of self-report depression (ηp2 = .08) and emotional avoidance (ηp2 = .05), and high levels of mindful awareness (ηp2 = .1). Explicitly increasing distance was associated with reduced emotional reactivity in individuals scoring high on cognitive reappraisal (ηp2 = .1). Our data suggest that the capacity to increase psychological distance in response to negative emotional provocation may depend on 1) depressive symptomology and trait emotion regulation styles, and 2) level of awareness (implicit vs. explicit).  Additional experimental and neurobiological studies of decentering may enhance our understanding of its underlying mechanisms while informing clinical efforts to promote decentering in a therapeutic context."  OK, I want to make a fairly quick pass across the various presentations I attended today.  I intend to come back to pull out the "therapeutic cherries" in later posts.

So I now upped and headed across to the symposium on "The role of compassion in mental health".  I caught the tail end of Caroline Falconer's presentation on using virtual reality technology for encouraging self-compassion.  I particularly wanted to hear the fine Willem Kuyken on "Does self-compassion attenuate reactivity in people at risk from depression?"  Sadly Willem hadn't been able to get to the conference, so the talk was given by his colleague & fellow researcher Anke Karl.  The abstract read: "Self-compassion may enable people at risk for depression to break the link between cognitive reactivity and a spiral of negative mood and thinking that can trigger depression (Kuyken et al., 2010). This experimental study showed that following a sad mood induction people at risk for depression able to deploy self-compassion are better able to repair sad mood. This has implications for how to build resilience in people at risk for depressive relapse."  Interestingly I can see from the abstracts book that the initial talk by another of Willem's colleagues Hans Kirschner might have been more practically useful with its comment that "We ... studied psychophysiological correlates of two meditation exercises (Loving Kindness Meditation and Compassionate Body Scan) designed to cultivate state self-compassion ... Further explorations of these findings suggested that responses to the self-compassion conditions were moderated by participants' tendencies to self-criticize. Individuals high in self-criticism tended to respond to the compassionate body scan (i.e., a more indirect approach to cultivate self-compassion) with higher activation of the positive affiliative affect system but not to the loving kindness meditation (i.e., a more direct approach to cultivate self-compassion), while those participants low in self-criticism showed the opposite pattern. This indicates that both forms of meditation can have beneficial effect on the positive affiliative affect system and point towards differential indications for offering them to individuals based on their tendencies to self-criticize."  This looks worth following up.  Then Paul Gilbert gave a conceptual talk on "What is compassion?" highlighting how much variety there is in what people have meant by this word.  In many ways this variety provides a welcome richness, but it's tricky when trying to do research in this area.

After coffee, Colin Espie gave an end-of-morning keynote on "The past, present and future of psychological therapy for insomnia disorder."  I have been to a day workshop on insomnia with Colin in the past.  What a wonderfully knowledgeable man he is in this whole area.  The abstract of his talk read: "Insomnia Disorder is extremely common and represents a risk factor for subsequent mental and physical health problems, yet it is poorly managed in practice. CBT has the strongest evidence base for treating persistent insomnia, but historically it has proven difficult to make it available. Digital (web and mobile) therapy offers a personalised behavioural medicine solution, that could stand alone or integrate with face to face therapy. This presentation will summarise the evidence base for various CBT delivery methods and propose a way forward for delivering effective care at population level."  It is interesting how a cluster of experts are pushing forward with web-based, often therapist-supported, delivery of carefully thought through, evidence-based treatment packages.  Colin's www.sleepio.com is just such an initiative ... excellent and, as a therapist, one can dovetail with this service, monitoring how one's clients are doing with the sleepio insomnia programme as well as receiving useful research updates and the opportunity to discuss relevant issues with colleagues.  

Then lunch and to a great skills class with Jennifer Wild on "Optimising video feedback for social anxiety disorder: Face-to-face and virtual techniques".  I have written extensively on this blog about use of video with social anxiety disorder ... see, for example, "Treating social anxiety disorder: video (and still) feedback".  It's wonderful though to get a chance to pick up tips from a hugely experienced expert in a particular area. Brilliant ... this single skills class was, for me, worth a good half of the full conference fee.  Happily I got a chance, standing in the queue for food at the barbecue in the evening, to say to Jennifer how much I appreciated what she shared with us.  I'll write a whole blog post about the skills class later.  Then finally an end of day keynote with my friend, James Bennett-Levy on "Why CBT therapists need to take a good look at themselves". James is having a busy conference giving a pre-conference workshop, a symposium and now this major lecture ... exhausting!  The abstract reads "This keynote will address questions such as: How do therapists develop therapy skills? What makes us good or poor therapists? What is reflective practice? What do we mean by ‘self-reflection'? What is the value of personal development in therapist training? Do we all need personal therapy, or are there other options?  Drawing on the Declarative Procedural-Reflective (DPR) model of therapist skill development (Bennett- Levy, 2006, Bennett-Levy & Thwaites, 2007; Bennett-Levy et al., 2009)) and research and writing across a number of countries (e.g. UK, Ireland, Germany, Australia, New Zealand, Austria, USA) over the past 15 years, James will argue that self-reflection and self-practice of therapy skills are central to the development of therapist competence and expertise in CBT. The talk will discuss current understandings of reflection, and examine the empirical evidence for the value of self-practice and self-reflection (SP/SR) in therapist training. It will conclude with some ideas about how, as CBT therapists, we can best ‘take a good look at ourselves' to enhance our professional, and personal, development".  Apparently the full lecture should be available on James's website.  

A very good full day.  I plan to revisit some of the main points in future blogs, but right now ... off to the second day of the conference's presentations ... and click here for a report on how the second day went.

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