Presentation to World Congress Cognitive and Behavioural Psychotherapies. Barcelona 2007. Modified version presented at IHRA Bangkok, 2009.

1. Lost and found in translation:
Sharing cognitive Behaviour therapy skills in Mauritius
Frank Ryan
Consultant Clinical Psychologist Honorary Research Fellow
CNWL NHS Foundation Trust Birkbeck College
London University of London
f.ryan@psychology.bbk.ac.uk

2. Background and Overview
• Spread of HIV through injecting drug use
• Need to engage injecting drug users into
treatment
• Health and social care professionals need to
acquire appropriate knowledge and skills
• Conclusion is that basic behaviour change
techniques can travel
f.ryan@psychology.bbk.ac.uk

3. f.ryan@psychology.bbk.ac.uk

4. f.ryan@psychology.bbk.ac.uk

5. Tuesday 7th Weds 8th Friday 10th
Thursday 9th Saturday 11th
Opening Motivating Impulse Affect Implementing
Ceremony & Engaging Control: Using regulation: CHANGE:
Cognitive –
Introduction Drug Users Using How to apply
Cognitive –
Setting the Into behaviour what we have
Scene; treatment therapy to behaviour learned.
managing (Lecture, cope with therapy to cope
expectations. Video & urges and with negative Evaluation.
Group work) craving mood states
Lunch Lunch Lunch Lunch Lunch
Introducing Reflective Video Video Closing
the listening and demonstration Demonstration Ceremony
CHANGE giving & practice: & practice:
Programme Feedback teaching Identifying
(discussion clients to negative and
and practice) manage unhelpful
craving & thinking in
urges ourselves and
clients
f.ryan@psychology.bbk.ac.uk

6. Sign of the times
f.ryan@psychology.bbk.ac.uk

7. Its all about CHANGE
• Change
• The role of the therapist is to
Habits
provide treatment aimed at
• And helping the client acquire insight
and self- regulation skills. This
• Negative involves working with addictive
behaviour and emotional
• Generation of dysregulation in a structured,
• hierarchical way.
Emotion
f.ryan@psychology.bbk.ac.uk

8. Keep it simple; keep it focused
• The CHANGE model was
designed to enable the
wider application of CBT
techniques among workers
in substance misuse and c0-
morbidity areas.
• It provides a simple
hierarchy to inform
treatment planning: address
substance misuse/impulse
control in advance of
emotional disorders –not
least because the latter are
made worse by the former.
f.ryan@psychology.bbk.ac.uk

9. The Four “M’s”
• Motivate (and engage)
• Manage impulses to use
• Manage your mood
• Maintain lifestyle
change
f.ryan@psychology.bbk.ac.uk

10. Feedback
• The overall mean score was 9.36
• Range 8-10
• Median 10.
• “We would wish that the course can continue so
as we can be better professionals to alleviate
clients lives, to have a better Mauritius. Many
thanks to you Dr Ryan – God bless you.”
• “Nice workshop-some practical sessions in
London would also be most welcome”
f.ryan@psychology.bbk.ac.uk

11. Do’ s and Don’t s
• Encourage small group • Use complex models
work in local language • Pre-packaged training
• Present simple model of materials such as DVDs
change but supply < “unless home
background reading for grown”>
those more likely to
benefit from this
• Emphasise pre-existing
core skills and reinforce
their use
f.ryan@psychology.bbk.ac.uk

12. Conclusions (i)
• The pragmatic nature of
CBT contributed to its
success in a diverse cultural
context.
• The most highly rated
session was an exercise to
structure a keyworking
session and use techniques
such as active listening,
expressing accurate
empathy, giving feedback
and goal setting.
f.ryan@psychology.bbk.ac.uk

13. Conclusions (ii)
 Sharing skills is crucial but
skills will not share
themselves!! Sustained
effort over a long period of
time is essential.
 High level visible support is
essential to launch and to
sustain new initiatives
 WCBCT should address the
challenge of a global role
f.ryan@psychology.bbk.ac.uk

14. Acknowledgements
United Nations Office on Drugs and Crime
Central &North West London NHS Foundation
Trust & colleagues on CBT Diploma Course.
National Treatment & Rehabilitation Centre for
Substance Abuse (Republic of Mauritius)
f.ryan@psychology.bbk.ac.uk