Workshop 3

CBT for Depression: Overcoming Treatment Barriers with Complex Cases

Stephen Barton, Stephen Holland and Hayley Tyson-Adams, Newcastle CBT Centre

Complex cases are often difficult to treat and are prone to relapse after CBT, particularly those with adverse childhood experiences (ACES), several previous depressive episodes and early-onset depression. These clients usually have multiple other problems, not just depression - for example, biomedical, other psychological, social, risk and healthcare factors. These can interact with therapist and service factors to create treatment barriers – this is one way to define and formulate clinical complexity. 

This workshop will: (a) encourage participants to reflect on one of their complex depression cases, (b) explore different types of treatment barriers, for example, low alliance potential, co-morbidities, emotional instability, interpersonal crises, hopelessness about treatment, client passivity, etc, (c) consider unhelpful and helpful therapist responses when trying to overcome treatment barriers

Key learning objectives:

  • To consider whether biopsychosocial, therapist and service factors interacted to create treatment barriers in your clinical case
  • To reflect on different types of treatment barriers and how they can best be overcome
  • To observe video demonstrations of unhelpful and helpful responses to treatment barriers

Stephen Barton is Head of R&D at the Newcastle CBT Centre. He is an experienced CBT therapist, supervisor and trainer with long-standing interests in depression, clinical complexity and interpersonal processes. His main goal is to develop CBT treatments that are more effective, and more lasting, for clients with complex mood disorders. Stephen Holland and Hayley Tyson-Adams are research therapists based in Newcastle, working on treatment research into complex depression.

Key References

Barton, S., Armstrong, P., Wicks, L., Freeman, E. & Meyer, T.D. (2017) Treating complex depression with cognitive behavioural therapy. The Cognitive Behavioural Therapist. Vol. 10. doi:10.1017/S1754470X17000149

Barton, S. & Armstrong, P. (2019) CBT for Depression: An Integrated Approach. Sage


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