I recently wrote a first blog post introducing the excellent workshop that Michelle Craske ran before this year's BABCP annual conference.  It's easy to see Michelle's work as only relevant for improving outcomes in exposure therapy of anxiety disorders.  However I think these ideas are important much more widely than this.  Probably most of us have significant areas of our lives where we would benefit if we had the belief & courage to change.  Self-determination theory research has underlined the wellbeing benefits of living more autonomously, while Shalom Schwartz's work on values highlights how self-direction in thought & action (when balanced with warm-heartedness & kindness) is so widely respected all around the world (for more on this important balance, see the se

This pre-conference workshop with Michelle Craske on "Exposure in the 21st century" was great.  A few years ago - in the blog post "Maximising exposure therapy" - I wrote "Michelle Craske & colleagues from the Anxiety Disorders Research Center of UCLA have, for many years, been publishing careful, challenging research on underlying mechanisms & on ways of boosting the effectiveness of exposure therapies for different forms of anxiety.  Michelle's list of publications & research presentations runs to 50 pages and begins with a study on musical performance anxiety published in 1984.

Michelle Craske & colleagues from the Anxiety Disorders Research Center of UCLA have, for many years, been publishing careful, challenging research on underlying mechanisms & on ways of boosting the effectiveness of exposure therapies for different forms of anxiety.  Craske's list of publications & research presentations runs to 31 pages and begins with a study on musical performance anxiety published in 1984.  As the presentation titles on her list show, for some years the majority of her many lectures at prestigious conferences all over the world have revolved around the theme of how to take evolving scientific findings about fear learning and use them to optimize exposure treatments for anxiety disorders.

Just as there were research papers on depression that stood out and got me thinking last month, so too there were particular papers on psychotherapy that I found more interesting than others. 

Here are half a dozen papers with anxiety relevance.  The first couple are about the interaction between genetic vulnerability (or resilience) and childhood experience.  The Stevens et al paper is an update on the large body of research looking at psychological genetic vulnerability/resilience in macaque monkeys and how this interacts with parenting quality to lead, or not lead, to emotional and neurophysiological disturbances in adulthood.  The Battaglia paper particularises this gene/environment investigation by looking at the connections between early human childhood separation anxiety, loss of a parent, and panic disorder in adulthood.  

Over nearly 35 years of practice as a doctor and psychotherapist I've assembled a collection of 300 to 400 handouts and questionnaires that I use in my work.  I'm gradually uploading most of these handouts to this website so people can use any that they'd like to.  The collection is searchable in the Good Knowledge section of the site at Handouts, questionnaires and other leaflets.  Of the twenty two subsections on this part of the website, one of the more frequently visited areas is the Increasing access to psychological therapies (IAPT) outcomes toolkit.  This is a pretty full hand of cards for the recommended IAPT assessment measures.  I've recently updated the list of downloadable questionnaires available by including:

Here are half a dozen recent studies involving cognitive therapy (CBT).  The first by Craigie et al explores the use of mindfulness-based cognitive therapy (MBCT) to treat generalized anxiety disorder (GAD).  Although, as one would expect, MBCT helped GAD sufferers, it was noteworthy that results "fall well short of outcomes achieved by past research".  This adds to my concern that mindfulness training may at times be being over-hyped - see a blog I wrote in September for for more on this.  The next study by Cuijpers et al also suggests limitations to the march of CBT with interpersonal psychotherapy looking a somewhat better candidate for prevention of depression onset.  I guess one could argue that CBT can - and probably more often should - include  behavioural interventions to promote improved relationships.  Click here for tools that can help this approach.   The third piece of research by Grey et al is exciting.  It challenges the Alice in Wonderland dodo bird suggestion that "everyone has won, and all must have prizes"

The "Improving Access to Psychological Therapies" (IAPT) initiative is very ambitious and exciting.  It states its principal aim is to support English Primary Care Trusts in implementing "National Institute for Health and Clinical Excellence" (NICE) guidelines for people suffering from depression and anxiety disorders.  IAPT go on to say that "At present, only a quarter of the 6 million people in the UK with these conditions are in treatment, with debilitating effects on society."

One aspect of this carefully planned initiative is strong encouragement to assess and monitor the progress of those who are getting help.  Visiting the IAPT "Outcomes Toolkit and FAQ" web page provides access to several freely downloadable documents.  The emphasis is on good assessment measures that are free to use.  See below:

IAPT Outcomes Toolkit 2008/9 PDF - this 81 page 1.1Mb Adobe PDF is the September 08 version with amended IAPT Paper Based Data Set Questionnaires.