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November 14 – 16, 2011, Cognitive Behavior Therapy Workshop Level ll: Personality Disorders and Challenging Problems

Dr. Judith Beck demonstrates a how to conceptualize a challenging case.

Last week at Beck Institute we held our Level 2 CBT Workshop on Personality Disorders and Challenging Problems. Psychologists, psychiatrists, social workers, counselors, and other health and mental health professionals traveled from all over the world, including Canada, India, Peru and nine U.S. states, to receive training in Cognitive Behavior Therapy.

Participants received professional training from Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D.  Lectures and role-plays emphasized the need for the therapeutic alliance in order to establish rapport.  Dr. Sokol

Level 2 participants watched multiple live patient sessions while at Beck Institute

discussed patient collaboration and made it clear that a therapist should always be there for the client.  The use of mood checks was discussed and participants were told that a patient will often start with negative emotions and it is critical to probe them for positives to counter the negatives.

CBT Worksheet Demonstration

Dr. Judith Beck (above) demonstrated how to use a variety of CBT worksheets for therapists to use, such as the Cognitive Conceptualization Diagram. Dr. Beck encouraged workshop participants to roleplay (left and below) with one another to practice cognitive therapy techniques for personality disorders and challenging problems. Click here to learn more about our CBT workshops and how to register for our next Level 2 in February 2012. See below for more workshop highlights:

 

CBT for Bipolar I Patients (Students Ask Dr. Beck – Part TEN)

Dr.  Aaron Beck describes how cognitive behavior therapy  has been applied to Bipolar I Patients. He begins by explaining the development of scales for measuring symptoms, and then discusses techniques which therapist’s can implement when approaching mania, insomnia, and maladaptive behaviors.

What research is Dr. Beck presently involved in? (Students Ask Dr. Beck – Part SEVEN)

This is the seventh question from the Q&A portion of Beck Institute’s 3-Day CBT Workshop on Depression and Anxiety for students and post-doctoral fellows, held on August 15 – 17, 2011. In this video Dr. Aaron Beck discusses research he is presently involved in and/or leading at the University of Pennsylvania. Dr. Beck explains the work being done by three different teams within his unit; including clinical trials with suicidal patients, groundbreaking research on CBT treatment for schizophrenia, and a community mental health center project involving dissemination of cognitive behavior therapy.

What is the synergistic effect of medication and CBT? (Students Ask Dr. Beck – PART SIX)

This is the sixth question from the Q&A portion of Beck Institute’s 3-Day CBT Workshop on Depression and Anxiety for students and post-doctoral fellows, held on August 15 – 17, 2011. In this video Dr. Aaron Beck discusses the evolution of neurobiological research examining changes in the brain before and after cognitive therapy; in particular, Dr. Beck notes how CBT has been shown to decrease inflammatory cytokines.

What can neurobiology teach us about Cognitive Therapy? – (Students Ask Dr. Beck — PART FIVE)

This is the fifth question from the Q&A portion of Beck Institute’s 3-Day CBT Workshop on Depression and Anxiety for students and post-doctoral fellows, held on August 15 – 17, 2011. In this video Dr. Aaron Beck discusses the evolution of neurobiological research examining changes in the brain before and after cognitive therapy; in particular, Dr. Beck notes how CBT has been shown to decrease inflammatory cytokines.

What is special about cognitive therapy? (Students Ask Dr. Beck – PART FOUR)

This is the fourth question from the Q&A portion of Beck Institute’s 3-Day CBT Workshop on Depression and Anxiety for students and post-doctoral fellows, held on August 15 – 17, 2011. In this video Dr. Aaron Beck discusses what is special about cognitive therapy, what is new theoretically in the field of CBT, and how cognitive behavior therapy has expanded. Dr. Beck explains his present notion of cognitive therapy – that it is based on a theory of psychopathology (information processing model), and the techniques that are utilized are those that can help to ameliorate the dysfunctional aspects of the individual’s beliefs, interpretations, and avoidance behaviors, as well as dysfunction in attention and memory. Dr. Beck mentions the main thrust of cognitive therapy will be to modify the dysfunctional cognitive processing. Please enjoy the fourth segment from this unique series:

An Exchange from Dr. Aaron T. Beck and Dr. Amy Cunningham

Dr. Aaron T. Beck wrote:

Dear Amy,

I just came across an article(1), in which neurophysiological processes in Borderline Personality Disorder were compared with normal controls. Basically, what the authors found was that borderlines, responding to aversive stimuli showed the usual activation of the amygdala. However, when they were asked to reframe the response (“it is not real, it’s only a picture?” or, react as an observer rather than as a participant), the borderlines showed an attenuated response in the dorsolateral prefrontal lobe and a sustained amygdala response. This is a rather graphic illustration of what we see in borderlines, specifically they have difficulty reframing their responses. So the picture is something like this: they are ultrasensitive to all kinds of events and respond with anxiety set as anger, etc (they score high on almost all of the dysfunctional attitudes on the DAS). They also have really poor impulse control. What this adds up to is that the best way to calm them down emotionally (the amygdala) is through the kind of strategies, suggested by Linehan and other DBT people, specifically self-soothing, acceptance, relaxation, and meditation. These are more likely, at least at the beginning, to reduce amygdala activity. Such strategies also help with engagement. After the patient is well into the self-soothing it may be possible to experiment with reframing. It might be best to start off with examples and see how the patient responds to them. The patient might be given an example not quite relevant to her and can practice alternative explanations, looking for evidence, etc. This is the kind of approach that we use with delusional patients. As the patient practices on the reframing of pseudo-examples, then it is possible to try some examples, from the patient’s own repertoire. Do let me know what you think of this approach.

Best, Dr. Beck

Dr. Amy Cunningham wrote:

Hi Dr Beck, Thank you so much for this! I completely agree that people with BPD struggle significantly with cognitive restructuring and reframing emotionally evoking situations. I often find that the patients experience the suggestion of reframing as invalidating the extent of their pain. I agree with your remark about their ultrasensitivity – I often explain the sensitivity as pains to patients comparable to an “emotional burn victim”. I completely agree that validation and self-soothing allow the person to be in a place where she can start to examine her cognitive distortions and search for more flexible ways of thinking about the situation. I find psychological flexibility, to be a central goal for my work with people with BPD. I also find it helpful to start with validation of their extreme emotional response, as it greatly assists with engagement, and allows the person to be willing, instead of willfully defending her position. I am very much looking forward to working with CTT and Women’s Space in helping them provide more effective services to people with BPD.

Best, Amy

Schulze, L., Domes, G., Kruger, A., Berger, C., Fleischer, M., Prehn, K., Schmahl, C., Grossmann, A., Hauenstein, K., & Herpertz, S.C. (2011). Neuronal Correlates of Cognitive Reappraisal in Borderline Patients with Affective Instability. Biological Psychiatry, 69, 6, 564-573.