Phobias: A Handbook of Theory, Research and Treatment
Leahy, Robert L., Journal of Cognitive Psychotherapy
Phobias: A Handbook of Theory, Research and Treatment Graham C. L. Davey (Ed.). Chichester, UK: John Wiley & Sons (www.wiley.com). 1997, 470 pp., $139.95 (hardcover).
Behavior therapy traces its roots to the treatment of specific phobia. Phobias are ubiquitous and are frequently seen in clinical practice as the central complaint, with depression and substance abuse occurring as secondary conditions. In DSM-IV, phobias comprise a range of disorders, including social phobia and agoraphobia, with an increasing emphasis on the cognitive factors underlying these disorders.
This volume is the best collection of articles on phobia that I have ever seen. The book is divided into three parts: "the nature and description of prevalent phobias," "the treatment of phobias," and the "general theoretical perspectives on aetiology and maintenance." Each chapter is written by an internationally recognized authority on the topic and most chapters have clear clinical significance. It is beyond the scope of this brief review to do justice to every chapter, so I shall limit my discussion to the chapters of special value to cognitive therapists.
The first chapter by Adrian Wells and David Clark is an excellent review of the cognitive model of social phobia, which contrasts, to some extent, with strictly behavioral models of systematic desensitization. Wells and Clark discuss the importance of eliminating safety behaviors, which often maintain the underlying belief that one should never appear anxious. The chapter by Paul Salkovskis and Ann Hackman is an excellent overview of the sophisticated information-processing model of panic and agoraphobia. The authors provide a cognitive conceptualization of agoraphobia avoidance, based on the patient's incorrect assessment of threat and reliance on safety behaviors, which prevent disconfirmation of the catastrophic predictions. The cognitive therapy of panic and agoraphobia involves attempts to induce or practice feared symptoms or behaviors in order to test the catastrophic predictions that one will stop breathing, faint, or collapse.
Michelle Craske and Melissa Rowe provide an interesting and informative comparison of behavioral and cognitive treatments of phobias. Of interest to cognitive therapists, they review Bower's associative network model, Macleod and Mathews' schema model, and Foa and Kozak's model of emotional processing. Clinicians are urged to attend to the use of behavioral techniques, such as exposure and habituation, as well as underlying cognitive schemata that affect selective attention and catastrophic predictions. The chapter by Merckelbach and deJong on evolutionary models of phobias was especially interesting. This provocative chapter describes the evolutionary adaptiveness of many phobias (e. …