What Makes Therapy Work? Towards a Science of Cognitive, Emotional, and Behavioural Change

An International Conference in Lund, Sweden, 9-11 June, 2008

Lund University main building The conference is organized by Forum Lundense, in cooperation with the Department of Psychology, Lund University, and with financial support from the Swedish Research Council.

Purpose of the conference: - to gather some of the world’s leading researchers on cognitive-behaviour therapy, emotional processing, interpersonal therapy, and related topics, - to summarize, analyse and discuss what we know so far about treatment mechanisms and principles, and processes of change, - to discuss how to best go forward with research on these matters, in a way that may lead to a cross-fertilization of ideas in this area of research, and serve as an impetus to new research developments and clinical applications.

Lund is situated in the attractive and expansive Öresund region, in the south of Sweden, close to Copenhagen, Denmark. Trains carry you directly from the Copenhagen Airport to the center of Lund, in less than an hour. Lund is one of the oldest cities in Sweden, with a history more than one thousand years old. Lund University is Sweden’s largest university in terms of teaching and research. Together, the university, science-park, multicultural atmosphere and historical surroundings make up a unique combination.

The Cathedral in Lund

The Cathedral in Lund was consecrated in 1145. From the 13th century Lund was Denmark's most important city - a city from which the archbishops exercised ecclesiastical power over all of Scandinavia.

What makes therapy work? Towards a Science of Cognitive, Emotional, and Behavioural Change Scandic Star Hotel, Lund, Sweden, 9-11 June, 2008

Scandic Star Hotel

The conference room, UARDA

Scientific committee: Lars-Gunnar Lundh, Department of Psychology, Lund University Lars-Göran Öst, Department of Psychology, Stockholm University Gerhard Andersson, Department of Behavioural Sciences and Learning, Linköping University; and Department of Clinical Neuroscience, Karolinska Institute, Stockholm Gardar Viborg, Department of Psychology, Lund University; Chairman of Forum Lundense

Lars-Gunnar Lundh

Lars-Göran Öst

Gerhard Andersson

GardarViborg

Organizational committee: Forum Lundense, with Gardar Viborg, Lars-Gunnar Lundh, Björn Gustavson, Jan-Erik Nilsson, Anna Pardo, Susanna Hatt, Erling Hansen, Jens Knutsson, Shahriar Faghigi, Nina Klarin, Njördur Viborg, and others. Technical organizer: SKD Eurokonf

What makes therapy work? Towards a Science of Cognitive, Emotional, and Behavioural Change Scandic Star Hotel, Lund, Sweden, 9-11 June, 2008

Purpose of the conference The last decades have seen important developments in psychotherapy research, primarily with regard to the development of evidenced-based psychological treatments for a large number of psychological disorders (e.g., Roth & Fonagy, 2005). Establishing that various treatment programmes can help alleviate different psychological dysfunctions represents an important step in the development of a scientifically based psychotherapy. However, it is only a first step. Experimental designs with randomization of the participants to different treatment groups can show that a certain treatment package works for the average participant with a certain kind of disorder, but not why or how the treatment works, or more specifically what it is in this treatment package that has effect, nor for which particular individuals with this particular disorder it is likely to work. Evidence-based treatment packages are likely to contain components that are fundamental to therapeutic change, but they may also contain elements that are redundant, or even elements that have a detrimental effect, in the sense of reducing the effects of the treatment package as a whole (e.g., Lilienfeld, 2007). To improve and optimize treatment, it is important to increase our understanding of therapeutic principles, mechanisms, and processes at a more detailed level (e.g., Castonguay & Beutler, 2006). The purpose of the conference is (a) to summarize and analyse what we know so far about treatment mechanisms/principles/processes in cognitive-behaviour therapy and related areas, and (b) to discuss how to go forward with research on these matters. Most importantly, a more explicit research focus on therapeutic principles, mechanisms, and processes may not only lead to a better understanding of what makes existing treatments work – a better knowledge of this will probably also contribute to improving existing treatment approaches still further.

References Castonguay, L.G., & Beutler, L.E. (2006). Principles of therapeutic change that work. Oxford: Oxford University Press. Lilienfeld, S.O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53-70. Roth & Fonagy. (2005). What works for whom? A critical review of psychotherapy research. New York: Guilford Press.

Program for the conference

SUNDAY 8 JUNE 10.00 – 17.00 Workshop (lunch 13.00-14.00) 18.00 – 21.00 Registration 18.00 – 21.00 Welcome reception

MONDAY 9 JUNE 8.00 – 9.00 Registration 09.00 Introduction: What makes therapy work? A multi-faceted question - Lars-Gunnar Lundh, Department of Psychology, Lund University

MODULE 1. ANXIETY DISORDERS 09.15 Mechanisms of change in psychological treatment of anxiety disorders - David M. Clark, Department of Psychology, Institute of Psychiatry, London, UK 10.00 Emotional processing for PTSD - Shawn Cahill, Center for the Treatment and Study of Anxiety, Pennsylvania University 10.45 Coffee 11.15 Does a transdiagnostic approach bolster or hinder treatment of anxiety disorders? - David A. Clark, Department of Psychology, University of New Brunswick, Canada 11.45 PANEL DISCUSSION (Clark, Cahill and Clark. Discussants: Lundh and Öst)

David M. Clark 12.30 Lunch

David A. Clark

MONDAY 9 JUNE, AFTERNOON MODULE 2. TRANSDIAGNOSTIC ISSUES 13.30 Retrieval competition as a basic mechanism in therapeutic change - Chris Brewin, University College London, UK 14.15 Mental imagery and emotion in treatment across disorders - Emily Holmes, Department of Psychiatry, University of Oxford, UK

14.45 Coffee

15.15 Comorbidity and shared mechanisms: The relevance of treating insomnia across disorders - Allison Harvey, Department of Psychology, University of California, Berkeley, USA 16.00 Implicit and explicit self processes in the treatment of anxiety disorders - Lusia Stopa, Department of Psychology, University of Southampton, UK

16.30 PANEL DISCUSSION (Brewin, Holmes, Harvey, and Stopa. Discussants: Lundh and Andersson)

Chris Brewin

Emily Holmes

Allison Harvey

Lusia Stopa

18.00 – 20.30 MINGLE BUFFET at Carlssons Trädgård and Kulturens Restaurang

TUESDAY 10 JUNE MODULE 3. DEPRESSION 09.00 Have cognitive interventions outlived their usefulness in the treatment of depression? - David A. Clark, Department of Psychology, University of New Brunswick, Canada 09.30 Depressive rumination - Investigating mechanisms to improve treatment - Edward Watkins, University of Exeter, UK 10.00 DISCUSSION

10.15 Coffee

10.45 Testing mediation in randomized comparative trials: Not as simple as it may seem - Robert DeRubeis, University of Pennsylvania, Philadelphia, USA 11.30 Mediation and moderation in the treatment and prevention of depression - Steven Hollon, Vanderbilt University, Nashville, Tennessee, USA

12.00 PANEL DISCUSSION (Clark, Watkins, DeRubeis, and Hollon. Discussants: Andersson and Öst)

David A.Clark

12.30 Lunch

Edward Watkins

Robert DeRubeis

Steven Hollon

TUESDAY 10 JUNE, AFTERNOON MODULE 4. INTERNET TREATMENT 13.30 Effective treatments via the Internet: what are the implications? - Gerhard Andersson, Department of Behavioural Sciences and Learning, Linköping University; and Department of Clinical Neuroscience, Karolinska Institute, Sweden

Gerhard Andersson 14.15 DISCUSSION (Discussants David M. Clark and Lundh) 14.45 Coffee

MODULE 5. EATING DISORDERS 15.15 Investigating the mechanisms of action of Cognitive Behaviour Therapy and Interpersonal Psychotherapy in the treatment of eating disorders - Rebecca Murphy, Oxford University Department of Psychiatry, Warneford Hospital, Oxford, UK 16.00 Mediators of change in the treatment of bulimia nervosa and binge eating disorder - Terence Wilson, Department of Psychology, Rutgers, State University of New Jersey, USA

Rebecca Murphy

Terence Wilson

16.30. PANEL DISCUSSION (Murphy, Wilson. Discussant: Andersson, Ghaderi)

TUESDAY 10 JUNE, EVENING 19.00 Conference dinner at the Academic Society in Lund

The Academic Society (The AF castle) The Academic Society was founded over 175 years ago, and combines its dignified age with a breadth in activities that makes it the core of student life in Lund. The AF castle is the students’ own house and meeting-place for a great number of activities, big parties, and student organizations, combined with a restaurant serving and a café. Buses will take you from the Scandic Star Hotel to the restaurant.

WEDNESDAY 11 JUNE MODULE 6. DBT, SCHEMA-FOCUSED THERAPY, AND MINDFULNESS-BASED TREATMENTS 08.30 What are the therapeutic mechanisms in Dialectical Behaviour Therapy? - Alan Fruzzetti, Department of Psychology, University of Nevada, Reno, USA

09.15 What are the therapeutic mechanisms in Schema-Focused Therapy? - Arnoud Arntz, University of Maastricht, the Netherlands

10.00 Coffee

10.30 Mechanisms of change in mindfulness-based treatments - Ruth Baer, Department of Psychology, University of Kentucky, USA

11.15 PANEL DISCUSSION (Fruzzetti, Arntz, Baer, Lundh)

Alan Fruzzetti

Arnoud Arntz

12.00 Lunch (only included for workshop participants)

13.00 – 17.00 Workshops

Ruth Baer

WORKSHOP PROGRAM SUNDAY 8 JUNE Rumination-Focused CBT Edward Watkins, University of Exeter, UK 10.00-17.00 (lunch 13.00-14.00) Room: Billeberga

WEDNESDAY 11 JUNE Methods of Teaching Mindfulness in Empirically Supported Interventions Ruth Baer, Department of Psychology, University of Kentucky, USA 13.00-17.00 (coffee break 15.00-15.30) Room: Baldringe

Prolonged Exposure Therapy for the Treatment of PTSD Shawn Cahill, Center for the Treatment and Study of Anxiety, Pennsylvania University 13.00-17.00 (coffee break 15.00-15.30) Room: Billeberga

Cognitive-Behaviour Therapy for Obsessive-Compulsive Disorder David A. Clark, Department of Psychology, University of New Brunswick, Canada 13.00-17.00 (coffee break 15.00-15.30) Room: Skabersjö