Robert Leahy, American Institute for Cognitive Therapy

Friday, Nov. 20, 9:30-11:00 a.m.

Clinical Grand Rounds 1
Cognitive Restructuring Versus Cognitive Defusion

Steven Hayes, University of Nevada

Dr. Robert Leahy will demonstrate cognitive restructuring using a variety of cognitive therapy strategies. The purpose of cognitive restructuring is to reduce the impact of a negative thought on the patient's emotions, behaviors, and relationships. This can be achieved using a variety of techniques and strategies in the therapy session and in self-help homework. These include identifying the relationship between automatic thought distortions and a variety of emotions, recognizing that there are alternative interpretations of reality, and examining the costs and benefits of beliefs and the consequences of new beliefs. Dr. Leahy will demonstrate how the cognitive therapist can assist in reducing the credibility of a belief by examining the evidence, using a double-standard technique approach, role-playing alternative beliefs, and using self-instruction to internalize new ways of responding to negative thoughts that will arise outside of the session.

Dr. Hayes will demonstrate cognitive defusion. Cognitive fusion refers to verbal / cognitive dominance in the regulation of behavior to the exclusion of other sources of stimulus control. According to the basic theory of language that underlies ACT (Relational Frame Theory: RFT) cognitive fusion is due in part to the pervasiveness of literal, reason-giving, problem-solving, and evaluative contexts sustained by natural language communities. While fusion is not necessarily harmful, it becomes so when overextended. Psychoeducation can be helpful when there is an absence of information, but in many clinical situations entanglement with thoughts is the more central issue. Because learning is additive, not subtractive, RFT suggests that in these situations it is often safer to create more flexible responding by diminishing the excessive impact of cognitive events, rather than addressing their content. ACT therapists do this by the creation of non-literal, non-evaluative contexts for thought, such as mindfully noticing thinking as it occurs and then redirecting attention toward more important matters. It would be very uncommon in an ACT session to do nothing but defusion work but for the purposes of demonstration in this session Dr. Hayes will attempt to use as defusion methods as much as seems reasonable given what the client brings into the room.

Friday, Nov. 20, 11:30-1:00 p.m.
Clinical Grand Rounds 2
Body Dysmorphic Disorder: What You See Is Not What I See

Fugen Neziroglu, Bio-Behavioral Institute

Body dysmorphic disorder (BDD) is a preoccupation with a physical defect that may not be there, or, if present, it is very minor but the individual’s concern is excessive. It is a very serious disorder that causes impairment in functioning and severe distress. Individuals with BDD have higher hospitalization rates than that of schizophrenics, suicide attempts are quite high, and suicidal ideation is present in 80% of BDD sufferers. If untreated, the individual usually becomes homebound. Despite the severity and a prevalence rate ranging from 0.7% to 13%, it is underdiagnosed and improperly treated.

In this presentation, Dr. Neziroglu conducts the initial consultation; the second session, illustrating engagement in therapy; and, finally, the fourth and sixth sessions, depicting CBT. During the initial consultation the client, Kathy, presents as a 24-year-old who has dropped out of school and has been unable to work consistently due to her preoccupation with her complexion and hair. She has seen many dermatologists and frequents beauty parlors and excessively buys hair products. Despite initial difficulties engaging the client, who believes only a plastic surgeon or a dermatologists can “fix” her problem, Dr. Neziroglu engages Kathy via motivational interviewing and proposing alternative hypotheses about her preoccupation. By the fourth session, Dr. Neziroglu introduces cognitive therapy, attempting to reduce Kathy’s overvalued ideation, and begins attentional training. Shortly thereafter, during the sixth session, Dr. Neziroglu and Kathy are engaged in exposure and response prevention.

In the question-and-answer session following the demonstration, Neziroglu will discuss how to connect and engage patients in treatment. This video is an excellent resource for clinicians at all levels who work with body image disturbance and specifically with BDD individuals.

Recommended Readings: Neziroglu, F., Khemlani-Patel, S., & Jacofsky, M. (2009). Body dysmorphic disorder: Symptoms, models and treatment interventions. In G. Simos (Ed.), Cognitive behavior therapy: A guide for the practicing clinician (pp. 94-112). New York: Routledge. • Veale, D., & Neziroglu, F. ( 2009). Body dysmorphic disorder: A treatment manual. London: John Wiley & Sons. • Wilhelm, S. (2006), Feeling good about the way you look: A program for overcoming body image problems. New York: Guilford Press.

Friday, Nov. 20, 2:00-3:30 p.m.

Clinical Grand Rounds 3
Cognitive-Behavioral Strategies in Family Therapy

Frank Dattilio, Harvard Medical School

This interview will demonstrate the use of cognitive-behavioral strategies as they are applied to family therapy. This single session demonstration will portray the use of assessment techniques, as well as case conceptualization and some early interventions for family problems.
Recommended Readings:
Dattilio, F. M. (2009). Comprehensive cognitive-behavior therapy with couples and families: A systemic approach. New York: Guilford.
Dattilio, F. M. (1998) (Ed.). Case studies in couples and family therapy: Systemic and cognitive perspectives. New York: Guilford.