Washington Hall - Bulgarian Red Cross

The Willpower Workshop

Target Audience: Cognitive Behavioural therapist or trainees with moderate level of experience; Experienced Cognitive Behavioural therapists

All forms of cognitive behaviour therapy (CBT) engage the client in efforts to overcome habitual and highly motivated patterns of thought or behaviour. This challenges willpower, the capacity to sustain the pursuit of long term goals in the face of distraction. Willpower will be described as equivalent to cognitive control. The Research Domains Criteria (RDoC) framework proposes these as core components of cognitive control: Goal selection Goal maintenance Performance monitoring Suppression/ inhibition (e.g. of counter-therapeutic goals) In CBT cognitive control is particularly influenced by attentional bias towards disorder specific cues and the constraints of working memory. These defaults require little or no willpower; whereas overcoming or suppressing these responses draws heavily on willed effort.  Willpower is also constrained by the limited capacity of working memory: distraction can dislodge therapeutically aligned goals.  The motivational component of willpower is strongly influenced by the availability and perceived value of rewards. However, the rewards associated with therapeutic change are delayed, whereas the rewards contingent on maintaining the status quo are more or less immediate.  This devaluing of delayed rewards needs to be addressed as part of the therapeutic dialogue and used to structure between session assignments. Willpower could be compromised by a wide range of challenges, including, ironically, a surfeit of cognitively demanding therapeutic exercises that could overload working memory.  Overall, the key is to ensure that the client is reinforced for their effort, by interim or proxy rewards that serve as milestones on the road to recovery. Learning objectives Understanding of the mental effort required to initiate and sustain therapeutic change Directly addressing willpower as an asset that has to be cultivated as part of therapy Identify the strengths and limitations of cognitive control and the fluctuating levels of motivation in any therapeutic journey. How to effectively apply knowledge of core cognitive and motivational processes to improve outcomes.   Teaching Methods Powerpoint presentation, role play, experiential exercises relating to willpower, small group discussion.

 A brief description of the workshop leader:

Frank Ryan is a clinical psychologist and cognitive therapist in Camden & Islington NHS Foundation Trust and an Honorary Senior Lecturer in Imperial College, London.  He has worked in the addiction arena for most of his career. He is the author of Cognitive Therapy for Addiction: Motivation and Change (Wiley Blackwell 2013 and Willpower for Dummies, John Wiley & Sons, 2014) Implications for everyday clinical practice of CBT The workshop introduces key transdiagnostic concepts derived from the Research Domains Criteria framework as well as recent research on willpower. The core constructs addressed in the workshop, cognitive control and reward processing are pervasive processes in the development of presenting problems but rarely explicitly addressed or engaged in the clinic setting. Practitioners would benefit, for example, from greater understanding of the limitations of working memory and the variable nature of motivation: strongly expressed in session but often depleted between sessions. Most of all, practice development would be enhanced by fostering resilience in the face of setbacks in the quest for long term change.   Relevant background readings about the topic Baumeister, R.F. & Tierney J. (2011) Willpower: Rediscovering the Greatest Human Strength. Penguin Books.   Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., et al. (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am. J. Psychiatry 167, 748–751. doi: 10.1176/appi.ajp.2010.09091379 Inzlicht. M et al (2014)  Why self-control seems (but may not be) limited. Trends in Cognitive Sciences. 18, (3) 127-133.   Ryan, F., Skandali, N.(Eds)  ( 2016). Reward Processing in Motivational and Affective Disorders. Lausanne: Frontiers Media.