Συνοπτικό Πρόγραμμα

Workshop-Program

Workshop Abstract

Workshop leader:
Emeritus Professor Michael Kyrios,
College of Education, Psychology and Social Work
Flinders University

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Workshop Title:

Basic and advanced cognitive-behavioural interventions in managing Obsessive Compulsive Disorder: Targeting mood, behaviours, cognitions and the self (Βασικές και προηγμένες γνωστικο-συμπεριφορικές παρεμβάσεις στη διαχείριση της Ιδεο–ψυχαναγκαστικής Διαταραχής (ΙΨΔ): Στόχευση στη διάθεση, τη συμπεριφορά, τις γνώσεις και τον εαυτό)

NOTE: The workshop will be conducted in English

Scientific background and description of workshop:

Obsessive Compulsive Disorder (OCD) is a complex but common and highly disabling disorder associated with high degrees of comorbidity that presents throughout the lifespan. Effective treatments for OCD include pharmacological and psychological interventions. From a psychological perspective, cognitive-behavioral conceptualisations of OCD have led to effective treatments, including exposure and response prevention (ERP), specific cognitive therapy (CT) techniques, and their combination in cognitive-behaviour therapy (CBT) programs. These can be applied in individual, group, bibliotherapy and internet-based modalities with or without medication. More recently, family-based interventions have also been used to target the family accommodation that maintains maladaptive behaviours in affected individuals. On the other hand, while dominating the etiological landscape, neurocognitive theories have generated limited interventions.

Our research in the 1990s concentrated on developing manualised individual and group treatments for OCD, based on CBT principles. We focused on cognitive strategies to augment established behavioural interventions. Cognitive and behavioural treatments for OCD are recommended by guidelines as first-line treatments (e.g., National Institute of Clinical Excellence). However, outcomes can vary and dropout/relapse rates remain high (McKay et al., 2015). Furthermore, access to CBT for OCD has been limited due to finite numbers of appropriately trained mental health professionals, as well as geographical and financial challenges in accessing trained professionals. In response, our research turned to (a) developing effective online CBT treatment programs with the aim of facilitating access through the internet, and (b) identifying factors predictive of poorer outcomes with the subsequent aim of developing augmented or novel treatment strategies based on new theoretical approaches that extended the cognitive-behavioural model of OCD.

With respect to identifying additional factors amenable to psychological intervention, our research focused on identifying self-based constructs associated with OCD. Based on the seminal theoretical work of Guidano and Liotti (1983), our research found that perceptions about the importance of the moral domain, ambivalence about one’s self-worth, and dissonance between implicit and explicit self-concepts are associated with greater OCD phenomena. On the basis of findings about the relevance of these self-based constructs, we propose the development of self-based interventions in the psychological treatment of OCD.

This workshop presents a conceptual model of OCD where concerns about transgressions in the moral domain and their impact on self concept are prominent, in conjunction with OCD-relevant cognitions and dysfunctional responses to intrusions. The conceptual model incorporates cognitive, self-construal, mood and behavioural factors, and has direct implications for engagement with affected individuals and their treatment. Following on from this model, traditional cognitive-behaviour therapy for OCD can be enhanced by incorporating interventions that target self-concept. Our group posits interventions that target self cognitions and self-related constructs can be integrated into CBT for OCD.

The first half of this full-day workshop focuses on describing OCD phenomena and theoretical understandings of its phenomenology. The workshop goes on to present traditional cognitive and behavioural strategies in the psychological treatment of OCD. Case examples will be used to illustrate key points, and to compare traditional and revised conceptualizations of specific cases. 

In the second half of the workshop, a range of self-based concepts are reviewed, focusing on the theoretical work of Guidano and Liotti (1983) who highlighted the centrality of attachment and self ambivalence in understanding the development and maintenance of OCD symptoms. The workshop presents a series of published research findings that support Guidano and Liotti’s theory.  The workshop then goes on to “workshop” cases using these augmented self-based understandings to develop management/treatment strategies. Workshop attendees are asked to bring at least one case to the workshop. If time permits, we will also discuss the relevance of self-based conceptualisations of related disorders such as hoarding disorder and buying-shopping disorder.

PLAN

10.00 am – 1.00 pm: PART A – OCD & Cognitive Behaviour Therapy

  1. What is OCD and its associated symptoms and phenomena?
  2. Developing a useful model that explains how OCD develops & is maintained
  3. Treatment outcome literature
    • focus on evidence-based psychological treatment strategies
    • investigating predictors
  4. Assessment of OCD
  5. Description of specific behavioural & cognitive treatment strategies
  6. Relapse prevention

 

LUNCH BREAK

2.00 – 5.00 pm: PART B – The self in OCD & treatment implications

  1. Expanding on the model of how OCD develops & is maintained
    1. focus on the importance of the self in OCD
  2. Description of self phenomena in OCD
  3. Description of various techniques that can be used to target aspects of the self.
    1. description of rationale & strategy
    2. description of specific techniques
    3. discussion of client engagement, therapeutic alliance & attachment
    4. discussion of therapist values in working with OCD

 

Cases examples will be discussed throughout,augmented by video presentations.

Key learning objectives

  1. Understand the cognitive-behavioural framework of OCD
  2. Understand the range of self constructs that can be used to further understand vulnerabilities to OCD cognitions and symptoms
  3. Develop case formulations for OCD cases that incorporate self constructs
  4. Develop engagement and intervention strategies to facilitate treatment of OCD
  5. Learn to integrate self-based conceptualisations into cognitive-behavioural treatment formulations

Training modalities

  1. Cognitive-behaviour therapy
  2. Self-based strategies using attachment and psychodynamic, narrative, Acceptance and Commitment Therapy, and metacognitive conceptualisations

Key references

  1. Ahern, C., Fassnacht, D.B. & Kyrios, M. (2018). Obsessions and phobias. Chapter in Oxford Handbook of Phenomenological Psychopathology. Stanghellini, M. Broome, A. Fernandez, P. Fusar Poli, Raballo A. & R. Rosfort (eds.) Oxford: OUP. ISBN: 9780198803157.
  2. Ahern, C. & Kyrios, M. (2016). Self-processes in Obsessive Compulsive Disorders. Chapter in Kyrios, M., Moulding, R., Doron, G., Bhar, S.S., Nedeljkovic, M. & Mikulincer, M. (Eds.) The Self in Understanding and Treating Psychological Disorders, Cambridge University Press, ISBN: 9781107079144, pp. 112-122.
  3. Ahern, C., Kyrios, M. & Meyer, D. (2015). Exposure to unwanted intrusions, neutralizing and their effects on self-worth and obsessive-compulsive phenomena. Journal of Behavior Therapy & Experimental Psychiatry, 49 Special Issue: SI Part: B, 216-222.
  4. Bhar, S.S. & Kyrios, M. (2016). The Self-Concept: Theory and research. Chapter in Kyrios, M., Moulding, R., Doron, G., Bhar, S.S., Nedeljkovic, M. & Mikulincer, M. (Eds.) The Self in Understanding and Treating Psychological Disorders, Cambridge University Press, ISBN: 9781107079144, pp. 8-18.
  5. Bhar, S. & Kyrios, M. (2007) An investigation of self-ambivalence in Obsessive-Compulsive Disorder. Behaviour Research & Therapy, 45, 1845–1857.
  6. Bhar, S.S., Kyrios, M. & Hordern, C. (2015). Self-ambivalence in the cognitive-behavioral treatment of obsessive-compulsive disorder. Psychopathology, 48(5), in Special Issue “The Self in Psychopathology” edited by M. Kyrios, B. Nelson, C. Ahern, T. Fuchs & J. Parnas
  7. Doron, G. & Kyrios, M. (2005). Obsessive Compulsive Disorder: A review of possible specific internal representations within a broader cognitive theory. Clinical Psychology Review, 25, 415–432.
  8. Fassnacht, D., Ali, K. & Kyrios, M. (2023). Extending the cognitive-behavioral model of Body Dysmorphic Disorder: The role of attachment anxiety and self-ambivalence. Top of FormBottom of FormJournal of Obsessive-Compulsive and Related Disorders, 37, 100803
  9. Kempke, S. & Luyten, P. (2007). Psychodynamic and cognitive-behavioral approaches of obsessive-compulsive disorder: Is it time to work through our ambivalence? Bulletin of the Menninger Clinic, 71, 291-311
  10. Kyrios, M., Ahern, C., Fassnacht, D., Nedeljkovic, M., Moulding, R., Meyer, D. (2018). Therapist- assisted Internet-based Cognitive-behavioral Therapy versus Progressive Relaxation in Obsessive-Compulsive Disorder: A Randomized Controlled Trial. Journal of Medical Internet Research, 20 (8), e242
  11. Kyrios, M., Fassnacht, D. & Ali, K. (2022). Clarifying identity and the self in a CBT context. Invited chapter in Menzies, R.G., Menzies, R.E. & Dingle, G. Existential concerns and cognitive-behavioral procedures: An integrative approach to mental health. Springer, ISBN 3031069315, pp. 185-206.
  12. Kyrios, M., Hordern, C., Fassnacht, D.B. (2015). Predictors of response to cognitive behaviour therapy for Obsessive-Compulsive Disorder. International Journal of Clinical & Health Psychology, 15, 181-190
  13. Kyrios, M., Mogan, C., Moulding, R., Frost, R.O., Yap, K. & Fassnacht, D. (2018). The cognitive-behavioural model of hoarding disorder: Evidence from clinical and non-clinical cohorts. Clinical Psychology & Psychotherapy, 25, 311-32.
  14. Kyrios, M., Moulding, R., Doron, G., Bhar, S.S., Nedeljkovic, M. & Mikulincer, M. (Eds.) (2016). The Self in Understanding and Treating Psychological Disorders, Cambridge University Press. ISBN: 9781107079144.
  15. McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D., Kyrios, M., Matthews, K. & Veale, D. (2015). Efficacy of Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder. Psychiatry Research, 227, 104-113.
  16. Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research & Therapy, 35, 793-802

Implication for everyday clinical practice of CBT

Given the complexities and limitations of existing approaches to managing clients with OCD, practitioners often need additional conceptual frameworks and skills to improve engagement and outcomes related to psychological treatment. This workshop will provide practitioners with a broader range of case and treatment formulation skills in managing OCD.

Brief description of workshop leader:

Mike Kyrios is an Emeritus Professor at Flinders University and maintains honorary positions at various universities where he has worked previously (Australian National University, University of Melbourne, Swinburne University), as well as the South Australian Health and Medical Research Institute (SAHMRI). He is an academic and clinical psychologist with expertise focusing on mental health, specialising in Obsessive-Compulsive, Anxiety and Mood disorders and behavioural addictions, and has leading expertise in wellbeing, evidence-based psychological treatments, including those that are delivered digitally, and psychological aspects of medical illness. His research and conceptual frameworks encompass behavioural, cognitive, neurocognitive, developmental and self-based methodologies.

While Mike has maintained clinical roles throughout his career (e.g., Royal Melbourne Hospital, Albert Road Clinic, private practice), in later years he worked mostly as a teaching and research professor, as a head of school, as a research centre director and, most recently, as a senior university executive at Flinders University where he was Vice President and Executive Dean in the College of Education, Psychology and Social Work at Flinders University. He has also maintained consultancy roles to various government bodies, community and consumer groups, and industry partners. Mike has set up two major research centres focusing on mental health and wellbeing, one at Swinburne and more recently at Flinders University. Although recently retired from a full-time academic position, Mike is currently involved in a global educational startup initiative and continues to support his research colleagues at Flinders University, the University of the Sunshine Coast and SAHMRI.

Mike has been associated with over $34 million in research funding as a primary investigator and has over 180 publications. He has given keynotes, talks, workshops and master clinician sessions nationally and internationally in his areas of expertise. His interest in the “self” in psychological disorders is reflected in numerous peer-reviewed publications and chapters, an edited book with Cambridge University Press, and a Special Edition of Psychopathology in 2015. Upon his retirement from full-time academic responsibilities, a volume of the Journal of Obsessive-Compulsive and Related Disorders is dedicated in his honour and that of long-time collaborator Professor Randy Frost.

Mike has undertaken editorial responsibilities for leading journals, including Behavior Therapy, Journal of Obsessive-Compulsive and Related Disorders, Behavioural and Cognitive Psychotherapy and the International Journal of Psychology amongst others. Mike has sat on various national grant review panels and has reviewed for international research funding bodies. Mike has sat on multiple local, national and international conference committees and was Scientific Chair for the 2010 International Congress of Applied Psychology and the 2016 World Congress of Behavioral and Cognitive Therapies.

Mike is a former President of the Australian Psychological Society (APS) and National Chair of the APS College of Clinical Psychologists. He was elected a Fellow of the APS in 2007 and an Inaugural Fellow of the Australian Association of Cognitive and Behavioral Therapy in 2016. He received the 2013 Ian Campbell Memorial Prize in Clinical Psychology from the Australian Psychological Society (APS) and 2011 Presidential Citation for Excellence from the American Psychological Association’s Society for General Psychology.