Last updated on 20th July 2019
I'm at the '9th World Congress of Behavioural & Cognitive Therapies' in Berlin. As is routine with these kinds of events, the day before is taken up with pre-conference workshops. There are 31 of them! 18 are full-day and the rest half-day. A lot of choice. I've gone for "Reimagining CBT for major depression" with Keith Dobson. The full title includes " ... : using a contextual framework to conceptualize and treat depression."
As you'd expect at a World Congress, Keith is a CBT heavyweight. His bio includes the comments: "Keith Dobson, Ph.D. is a Professor of Clinical Psychology at the University of Calgary. His research has focused on both cognitive models and mechanisms in depression, and CBT for depression. Dr Dobson’s research has resulted in over 250 published articles and 80 chapters, 15 books, and conference and workshop presentations in many countries. Dr Dobson has been actively involved in organized psychology in Canada, including a term as President of the Canadian Psychological Association. He is a former President of both the Academy of Cognitive Therapy and the International Association for Cognitive Psychotherapy and is the President of the Canadian Association for Cognitive and Behavioural Therapies." His University of Calgary webpage gives more information and his downloadable CV runs to well over a 100 pages! At 65 years old, Keith is coming towards the end of a long & distinguised career. It should be a pleasure to hear what he has to say about treating depression.
The workshop description states: "Cognitive behavioral therapy for depression has been one of the most intensively studied forms of psychotherapy. It has ongoing evidence for its absolute efficacy, but declining evidence for its superiority over other treatment models for depression. This workshop argues that part of the need is to reimagine CBT for depression in a more holistic manner, and to use recent data on the risk and resilience factors, to build a current and contextualized framework to conceptualize and treat major depression. This workshop will provide a contemporary framework to view depression that builds on proven methods but enhances that framework and thus provides more skills for CBT therapists, more flexibility in treatment, and a significant opportunity to help more patients who struggle with the problem of clinical depression. The focus of the workshop will be on conceptualization and case planning; while major evidence-based treatment methods will be described, this will not be a major focus of the workshop.
Key learning objectives:
Understand the recent evidence on risk and resilience factors in major depression.
Develop an enhanced and contextualized framework to conceptualize depression.
Develop a model to match treatment methods to the newly presented framework.
Implications for everyday clinical practice of CBT
This workshop will help clinicians to hone their case conceptualization skills, to develop a more comprehensive and contemporary model of major depression and select methods that are likely to be successful when working with depressed clients. From a practical perspective, this approach should yield higher success rates and fewer relapses, more satisfaction among patients, enhanced competence among therapists, shorter wait lists and enhanced patient care."
What's not to like? Actually I like the whole look of this workshop ... except I'm a little uneasy about that last sentence "From a practical perspective, this approach should yield higher success rates and fewer relapses, more satisfaction among patients, enhanced competence among therapists, shorter wait lists and enhanced patient care." Research on depression over the years has been littered with the wrecks of new attempts to improve outcomes. Keith Dobson will know this only too well. " ... should yield higher success rates ... " is a statement that cries out for verification. So that's my understandable 'doubting Thomas' position. I'm still looking forward to the workshop though ... and plan to write more about how it turns out.
... and now I'm back in my Airbnb after today's workshop ... how did it go?
I found the workshop a bit disappointing ... helpful in some ways ... and interesting ... but a bit disappointing. And this wasn't helped by what was billed as a workshop turning out to be a whole day of slides with some question & answer thrown in ... but otherwise no active learning or audience involvement. I wonder about jetlag too. I've worked with North American presenters before who weren't at the top of their game on the first day of their presentations and then picked up very noticeably as they began to adapt to our time zone.
But Keith is definitely a very senior figure in CBT circles with excellent research contributions under his belt ... and some very well received books that he has written and edited too. This made what he said was probably the main message of the day, even more memorable. So he underlined that we now know so much more about risk factors for depression ... biological, psychological & social ... that we can respond in more targeted ways. He went on to comment that in maybe 10 years or so, we probably won't be talking about a 'cognitive model' of depression so much as a 'holistic model' or a 'biopsychosocial model'.
This felt affirming of much of what I too feel, and where I think much of the research literature is taking us. The 10-session 'How to live well: a shared exploration' course that I run focuses strongly both on lifestyle factors (exercise, diet, sleep & 'addictions') and on relationships (Dunbar's model, social identity theory, conflict resolution, etc). In a way, Keith's discussion of these areas felt affirming but a little clunky, as if he was moving a bit outside his major areas of expertise.
He made a series of interesting points about exploring patient expectations for treatment (maybe worth using a questionnaire to assess confidence/expectancy here); about exploring carefully with the patient the causes of missed appointments; about developing 'homework' assignments as one moves through different issues during the session (and simply listing & overviewing at the end of the session); and about suicide risk being strongly linked to hopelessness and the value of targetting sources of hopelessness,
For more on the three day conference proper, see the next post "CBT World Congress: 1st conference day - chronotherapy, sleep, PTSD, bipolar disorder, and emotions".