Well ... here I am again at one of the British Association for Behavioural & Cognitive Psychotherapies (BABCP) annual summer conferences.  It's before breakfast on the first morning and I'm a bit wrapped in a funny mix of feelings.  It's about 6.30am on a stunning morning.  The view from my room is of a lovely sun-splashed green lawn leading to a lake.  I'm really looking forward to the conference too.  It's got all kinds of goodies in it. Fascinating.  But in the train on the way down from Edinburgh yesterday, I 'tweaked' my back.  It stiffened up overnight and when I first got going this morning, I wondered if I was going to be able to make it to the conference today.  Well, it seems to be loosening up.  Dignified cautious posture & movements are on the menu just now.  It seems like there's a good chance it will progressively ease over the next few hours.  Fingers crossed!

So today is for pre-conference workshops.  Initially there was an extensive choice of nineteen full day workshops and there are still eighteen options - I see from the information sheet I was given last night that one workshop has been cancelled.  Happily not the one that I booked for - "Emotion regulation therapy" with Doug Mennin from the City University, New York and David Fresco from Kent State University, Ohio.  Their website "Emotion regulation therapy for chronic anxiety and recurring depression" gives a wealth of material about this approach.  Today's workshop publicity reads: Despite the success of cognitive behavioral therapies (CBT) for emotional disorders, a sizable subgroup of patients with complex clinical presentations fails to evidence adequate treatment response.  To address these challenges, contemporary CBTs, focusing on metacognition, mindfulness, and acceptance (e.g., MBCT, ACT, DBT, ABBT, MCT, CFT) have been developed and have begun to show efficacy for complex conditions such as chronic generalized anxiety and major depression. Generalized anxiety and major depressive disorders (often termed “distress disorders”; e.g., Watson 2005) are commonly comorbid and appear to be characterized by temperamental features that reflect heightened sensitivity to underlying motivational systems related to threat/safety and reward/loss. Further, individuals with these disorders tend to perseverate (i.e., worry, ruminate) as a way to manage this motivationally relevant distress and often utilize these self-conscious processes to the detriment of engaging new contextual learning. Emotion Regulation Therapy (ERT) is a theoretically-derived, evidence based, treatment that integrates principles from traditional and contemporary cognitive behavioural treatments (e.g., skills training & exposure) with basic and translational findings from affect science to offer a blueprint for improving intervention by focusing on the motivational responses and corresponding regulatory characteristics of individuals with distress disorders. Open and randomized controlled psychotherapy trials have demonstrated considerable preliminary evidence for the utility of this approach as well as for the underlying proposed mechanisms. In this workshop, attendees will learn to help clients to 1) expand their understanding of anxiety and depression using a motivational and emotion regulation perspective; 2) cultivate mindful awareness and acceptance of sensations, bodily, responses, and conflicting emotions; 3) develop emotion regulation skills that promote a distanced and reframed meta-cognitive perspective; 4) apply these skills during emotion-based exposure to meaningful behavioural actions and associated internal conflicts to taking these actions; and 5) build a plan to maintain gains and take bolder action despite the ending of the therapeutic relationship.

Learning objectives: * Expand one’s understanding of anxiety and depression using a motivational and emotion regulation perspective; * Increase familiarity with ERT skills designed to promote mindful awareness and emotion regulation: * Learn how these skills can be used during emotion-based exposure to meaningful behavioural actions and associated internal conflicts to taking these actions.

The training modalities in this Workshop will be lecture, demonstration, skills training, role-play, video

Clinicians who attend this workshop will be better able to treat a refractory group of clients (clients with comorbid chronic anxiety/depression, those who are highly “emotional” and continuously perseverate). They will be able to better identify the emotional experiences of their clients and aid clients in doing so “on the spot” in their everyday lives.  They will learn tools to impart to their clients to strengthen abilities to become more flexibly aware of their emotions, to manage them more effectively, and to engage more thoughtful actions as a result of this emotional clarity and regulation. Overall, clinicians will become more comfortable working with a difficult group of clients and feel more confident in engaging with emotions in sessions with these clients.

Over the past fifteen years, Dr. Douglas Mennin has developed an active program of research in clinical trials and basic research into the nature of mood and anxiety disorders. While on faculty at Yale, he was also Director of the Yale and Anxiety Mood Services (YAMS), where he conducted trial research and supervised students in conducting empirically based treatments for refractory cases with mood and anxiety disorders.  Dr. Mennin has conducted a number of studies of the basic physiological mechanisms of generalized anxiety and major depression and has recently been examining the role of worry and rumination in maintaining and exacerbating immunological processes such as chronic inflammation. He has also developed and evaluated an emotion regulation-based intervention for generalized anxiety and depression that was funded through an NIMH R34 mechanism. In a series of open trials and RCTs, this approach has yielded very strong effects in treating typically refractory disorders. Further, this work has identified a number of cognitive, physiological, and neural mechanisms that may mediate symptomatic outcome. He has also recently adapted this approach into a web-based training, which is currently being applied to caregivers of patients with cancer. Dr. Mennin’s role on these projects has been to further develop this emotion-regulation based CBT as well as to train and supervise protocol therapists at the performance sites on both procedures of treatment and assessment. In both applied and basic research, Dr. Mennin has trained numerous graduate students and post- baccalaureate research assistants on diagnostic and physiological assessment and mentored them on the development of independent studies that were routinely presented at national conferences or published.  To date, in addition to publications listed below, this line of work has yielded an authored book with Guilford (Mennin & Fresco, under contract), one of the inaugural “spotlight presentations” at the annual meeting of the Association for Behavioral and Cognitive Therapies, and numerous invited addresses.

David M. Fresco is an associate professor of psychology at Kent State University and adjunct associate professor of psychiatry at Case Western Reserve University School of Medicine. He directs the Psychopathology and Emotion Regulation Laboratory (PERL) and is a Co-Director of the Kent Electrical Neuroimaging Laboratory (KENL). He received his PhD from the University of North Carolina at Chapel Hill and completed a postdoctoral fellowship at Temple University. His program of research adopts an affective science perspective to the study of anxiety and mood disorders. Working at the interface of cognitive behavioural and emotion regulation approaches, he conducts survey, experimental, and treatment research to examine factors associated with major depressive disorder (MDD) and generalized anxiety disorder (GAD) including metacognitive factors (e.g., explanatory flexibility, decentering, rumination, worry), peripheral psychophysiology, and emerging work from affective neuroscience, utilizing neuroimaging and electrophysiological techniques. Another focus of the PERL lab is the development of treatments informed by affective and contemplative neuroscience findings that incorporate mindfulness meditation and other practices derived from Buddhist mental training exercises. Much of Dr. Fresco’s NIH-funded treatment research has focused on the infusion of mindfulness into Western psychosocial treatments. He is presently Associate Editor for two journals, the Journal of Consulting and Clinical Psychology and Cognitive Therapy and Research. He is also a frequent reviewer for the Interventions Committee of Adult Disorders (ITVA) of the National Institute of Mental Health.

References/further reading:  * Fresco, D. M., Mennin, D. S., Heimberg, R. G., & Ritter, M. R. (2013).  Emotion Regulation Therapy for Generalized Anxiety Disorder. Cognitive and Behavioral Practice, 20, 282-300. doi:10.1016/j.cbpra.2013.02.00. * Mennin, D. S., & Fresco, D. M. (2013).  What, me worry and ruminate about DSM-5 and RDoC?: The importance of targeting negative self-referential processing. Clinical Psychology:  Science and Practice, 20, 259-268. * Mennin, D. S. & Fresco, D. M. (2014). Emotion Regulation Therapy (pp. 469-490). In J. J. Gross (Ed.)  Handbook of Emotion Regulation, 2nd Ed. New York: Guilford Press. 

Gosh that's plenty of information ... maybe a bit too much.  So how did the workshop actually go? ... see tomorrow's post "Pre-conference workshop on emotion regulation therapy with Doug Mennin & David Fresco (2nd post)".