Last updated on 5th August 2010
The second day of the annual BABCP conference in Manchester started bright and early. I wrote a bit in my room - I've already written a couple of posts about the first day of the conference - before heading down for an early breakfast. Breakfast was good - much better than yesterday's disappointing packed lunch. Social too, chatting to a couple of other "early birds" about the conference and CBT more generally. Back to my student room - the whole conference is at the main Manchester university. Then a good difficulty to have - trying to decide between two interesting options - either Nick Tarrier running a "skills class" on "Broad Minded Affective Coping (BMAC): a new and positive technique for the CBT tool box" or a symposium with the initially unappetizing title "Understanding anhedonia and positive information processing in depression: from basic science to clinical intervention". The latter certainly didn't get my prize for most enticing symposium title, but it did get my vote over fourteen other parallel presentations for where I planned to spend the first couple of hours or so of the morning. Both the Tarrier skills class and the symposium interested me as they focused on the overlap between CBT and Positive Psychology.
Tarrier's class publicity ran "This mini-workshop will describe a new cognitive-behavioural treatment Broad Minded Affective Coping (BMAC) based upon Frederickson and colleagues' ‘broaden and build' theoretical model of positive emotions ... BMAC aims to increase positive experiences as a platform to increase positive behaviour and functioning ... BMAC aims through the use of mental imagery to elicit positive past memories and the positive emotional states associated with them ...Preliminary results indicate that it has clinical feasibility and acceptability and is applicable to people suffering a range of psychological problems and disorders." The publicity then goes on to cite a reference: Tarrier, N. (2010) "Broad minded affective coping (BMAC): a positive CBT approach to facilitating positive emotions". So this workshop focused very much on the top left quadrant - "lack of encouraging, positive memories" - in the four quadrant "Working with past & future images" diagram I illustrated in yesterday's post. I also wrote about Barbara Fredrickson's work when reporting from the European Conference for Positive Psychology in Copenhagen last month. Interesting to see this kind of workshop already popping up at a major CBT conference. However, it's CBT's ability to get grungy with pretty hard science that I especially respect. The alternative "Anhedonia and positive information processing in depression: from basic science to clinical intervention" symposium promised this more chewy prospect.
Barney Dunn, from the Medical Research Council's Cognition and Brain Sciences Unit, introduced the symposium's four talks and gave the first - "Experimental investigations of positive information processing in depression". He cited a 2010 study by Wood showing absence of wellbeing is predictive of depression levels at 10 year follow up. This chimes with Corey Keyes's talk in Copenhagen last month showing low levels of wellbeing - "languishing" rather than "flourishing" - to be highly predictive of future psychological distress. Barney talked too about developments in Behavioural Activation (BA) treatment for depression involving "Attention to experience" interventions to help reduce rumination - see for example my post on Ed Watkins's workshop at last year's conference. Barney linked this to findings from research using Ruth Baer & colleagues' "Five facet mindfulness questionnaire (FFMQ)" showing that better scores on the two facets "observe" and "act aware" are associated with higher levels of reported happiness. Apparently "observe" facet scores are not particularly reduced in depressed subjects, but "act aware" scores are reduced - probably due to increased rumination - and this seems to mediate the lowered enjoyment (reduced levels of positive emotion) associated with depression. For a downloadable copy of the FFMQ, see this website's "Wellbeing and calming skills" page. Barney described how - in his clinical work - when asking clients to keep a positive activity schedule, he also now asks them to keep a positive activity log where they "elaborate" their positive experiences describing the linked feelings, sensations, images, etc (possibly best done from a first person, field rather than third person, observer perspective). It seems an up-to-date rumination-reducing version of the hippie injunction to lose our heads and come to our senses. Dunn also reported on findings from asking people suffering from depression and people with no depression to elaborate happy, sad, and neutral memories. Both depressed and non-depressed subjects reported increased happiness when elaborating happy memories and increased sadness when elaborating sad memories. However depressed subjects also reported that when elaborating happy memories they experienced greater happiness but also often experienced some associated increase in sadness and fear. When elaborating sad memories they experienced greater sadness, but also considerably greater disgust and anger. Barney wondered what the implications for therapy might be here. I would have thought this linked clearly with Emily Holmes's suggestion - illustrated in yesterday's diagram "Verbal representation v's imagery construction" - that activation of "verbal representations" allows comparisons e.g. "I know this is a happy memory, but how sad that I so rarely get happy moments like this now" and so on. He mentioned the potential applicability of Paul Gilbert's Compassion Focused Therapy, and I would also wonder about dialogue ideas from Les Greenberg's Emotion Focused Therapy (when anger is directed at others), and ideas too from Fred Bryant's Savoring. This talk left me thinking in a series of areas - about savouring for past, current and future activities, and particularly about the complex set of cross-currents involved in encouraging people to reflect on and try to boost happy memories. More on this when I comment on Jamie Pennebaker's talk later in the day.
The second talk was by Andrew McLeod of Royal Holloway university. It was entitled "Anticipating future positive experiences: its role in wellbeing and mental health". So in yesterday's four quadrant "Working with past & future images" diagram, we're now moving into the top right quadrant "lack of encouraging, positive futures". The abstract to McLeod's talk commented " ... In the realm of future-directed thinking, there is clear evidence that the lack of positive future thinking is different from the presence of negative future thinking, and that reduced positive future thinking rather than increased negative future thinking characterise the cognitions of those who are depressed and suicidal. These findings suggest that interventions to enhance positive future thinking may be valuable in clinical practice. Evidence of the effectiveness of such interventions will be reviewed with a particular emphasis on enhancing goal setting and planning abilities to increase anticipation of future positive experiences." I've blogged briefly before on Andrew McLeod's work. Goals are a big, complex subject - goal identification, goal selection, management of inter-goal conflicts, goal implementation, management of goal success and goal failure. Mm ... . The "Wellbeing, time management & self-determination" page of this website contains a good deal of relevant material. Another symposium at this conference - "Utilising control theories in the science and practice of CBT" (see pages 30 to 32 of the "Conference abstracts" book) has useful things to say about the dangers of " ... unresolved conflict between personal goals", " ... unsatisfactory rates of progress towards important goals and an inability to disengage from unobtainable goals" and issues of difficulty level, partial engagement, and approach v's avoidance goals. McLeod commented that, in his experience, helping depressed people work better with goals reduces their negative mood more obviously than it increases their positive mood. This should to be put in context - for example the recent paper by Sheldon, Lyubomirsky et al "Persistent pursuit of need-satisfying goals leads to increased happiness: A 6-month experimental longitudinal study" found clear improvements in happiness from encouraging (mostly non-depressed) participants to pursue "need-satisfying" goals (in contrast to goals that were simply aimed at improving "life circumstances").
Andrew's talk led naturally to the next presentation by Helen Barlow "Evaluating a self-help, positive goal-focused intervention to increase well-being in people with depression". This seemed to have built from the earlier 2008 study "Increasing well-being through teaching goal-setting and planning skills: results of a brief intervention" and explored how depressed clients might respond to this intervention despite getting minimal actual therapist contact. The message seemed to be - "hopeful, but if reducing the 'guided' aspect of 'guided self-help' one is going to need to work hard on optimising the teaching materials given to the clients - and even then you might do better to add a bit more therapist input". The final presentation to the symposium was by Richard Moore "Fostering positivity in cognitive therapy for depression: a clinical perspective" which added a more chatty personal perspective to the symposium.
I'm getting a bit verbose here. The next two presentations I went to on this second day of the conference, I'll write about later. They were Jamie Pennebaker on "Expressive writing in clinical practice" and a symposium chaired by David M Clark "Innovations in the delivery of cognitive therapy for anxiety disorders". More about these in later posts. Tomorrow though I post on David's plenary lecture "IAPT: achievements, lessons and the future".