British Style Cognitive Behavior Therapy

Article excerpt

British Style Cognitive Behavior Therapy Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide. Keith Hawton, Paul M. Salkovskis, Joan Kirk, and David M. Clark (Eds.). Oxford: Oxford University Press, 1989. (456 pp.). $32, hardbound.

As one may guess from the spelling of the title, this guidebook was written largely by British authors. The British perspective comes through the context many times in this comprehensive compilation of some of the field's leading experts of applications of cognitive-behavioral theory to the hard work of therapy. The range of disturbances considered are not limited to the most severe disorders, as an American connotation of "psychiatric problems" would imply, but includes matters such as marital problems, sexual difficulties, and problem-solving as well.

The editors intended the book to provide an integrated guide to the practice of cognitive behavior therapy that deliberately attempts to remedy a common deficiency found in related literature, namely, the assessment of suitability for such treatment. In this and other pragmatics, they succeeded well. Although the chapters are arranged topically around common psychiatric problems with the use of a standard format, practical matters such as focused assessment, engagement of patient collaboration, and treatment resistance are addressed almost routinely in every chapter. The first chapter gives a brief history of the development of cognitive-behavioral principles and treatment to set the stage for a generic second chapter detailing the recommended procedures of a cognitive-behavioral assessment. This approach highlights a characteristic strength of this treatment orientation in that the content of an individual's problems become conceptualized clearly, thus promoting focused interventions. The related matter of attending to the helpee's process, however, tends to be de-emphasized by the same characteristic, especially given this orientation's tendency to be therapist-centered (despite disclaimers to the contrary).

The book is aimed ostensibly at experienced therapists to encourage them to "start using cognitive-behavioral treatments in their clinical work." The standard format, nonetheless, should facilitate the novice's acquisition of both the orientation and the procedures unique to cognitive behavior treatment. Remaining chapters address the following areas: anxiety states (panic and generalized), phobic disorders, obsessional disorders, depression, somatic problems, eating disorders, chronic psychiatric handicaps, marital problems, sexual dysfunctions, and problem-solving. Each of the editors, as well as contributors, wrote or coauthored one or more of the topical chapters, and lend further coherence to the book as a whole by referring to each other's remarks.

Every topical chapter begins with a description of the condition, delineates relevant assessment procedures as prescribed from Chapter 2, formulates typical problem scenarios, and then proceeds step-by-step through treatment planning and collaborations. Tedious pedantry is minimized by frequent examples, case verbatims, and other anecdotal material that also illustrates the English social context (many times unintentionally). Clark's discussion of anxiety states, fo example, sets the pace by majoring in treatment concepts and procedures. Only two pages are devoted to alternative treatments and empirical studies of the subject. While any one of the chapters could be utilized as a cognitive-behavioral primer, this chapter does an excellent job in depicting cognitive mechanisms in the etiology and maintenance of the multidimensional experience of anxiety. Lik every other chapter, specificity of treatment is advocated and demonstrated; each behavioral, physiological, and cognitive aspect of the condition is carefully described, along with ways the helper/helpee can collaborate to monitor and "experiment" with homework plans. Fortunately, one section emphasizes the voluntary production, as behavioral experimentation, of physiological arousal endemic to panic states, a procedure that is starting to be understood as perhaps the primary key to panic treatment (Barlow & Cerny, 1989). …


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