This book is one of the latest additions to the Clinician's Toolbox series from Guilford Press. It is written by 2 psychologists with a wealth of experience in providing cognitive behaviour therapy (CBT) to individuals suffering from depression and anxiety disorders, as well as in training clinicians to administer CBT. The authors have also published several other practical books on cognitive therapy for practitioners.
Leahy and Holland provide step-by-step CBT protocols, adapted from manuals that have been extensively tested at research centres around the world. The protocols are written for the clinician who may be constrained with respect to the number of sessions that he or she can offer, as well as by the length of time available for each session.
The first chapter provides an overview of issues related to CBT in managed care settings. The 7 chapters that follow provide treatment plans for particular syndromes, including depression, panic disorder and agoraphobia, generalized anxiety disorder, social phobia, post-traumatic stress disorder, specific phobia, and obsessive–compulsive disorder.
The structure of chapters 2 through 8 is similar; each begins with a description of the disorder in question and suggestions for differential diagnosis. The authors review behavioural and cognitive models for the disorder, provide information regarding other contributing factors and briefly review the research on cognitive behavioural treatments for the disorder. An overview of assessment and treatment strategies is provided next, followed by a case example and a detailed, session-by-session description of the treatment. Each chapter also has a section on trouble-shooting and an appendix, which details how to administer particular behavioural and cognitive interventions.
Overall, Leahy and Holland provide an excellent overview of cognitive and behavioural strategies for treating anxiety. Strengths that warrant mentioning include: comprehensive forms, which can be used to facilitate the initial clinical assessment; excellent handouts and questionnaires for patients; and a CD-ROM containing reproducible copies of all handouts and forms, as well as expanded information about cognitive behavioural techniques and medications.
Generally, the treatments recommended in this book are consistent with the research on CBT for anxiety disorders and depression. However, there are a few exceptions where certain treatment interventions are recommended despite a lack of research supporting their use for the disorder being discussed. For example, they recommend a 6-session treatment for specific phobias that includes imaginal exposure, in vivo exposure, relaxation training and cognitive therapy. However, it is well established that most individuals with specific phobias (e.g., of animals, blood, needles) respond to 1 or 2 sessions of focused exposure, without these other interventions. In fact, another technique that is empirically supported for blood phobia (i.e., applied tension) is not discussed at all in the specific phobia chapter. In addition, relaxation training is included as a recommended treatment in all of the chapters on anxiety disorders, even though it is empirically supported only as a treatment for generalized anxiety disorder, and Appendix A recommends the use of thought-stopping and distraction for temporarily managing fear, despite the fact that most behavioural researchers recommend against using these strategies.
A second limitation of the book concerns the sections on assessment measures for anxiety disorders. These sections do not include the most important measures for assessing individuals with anxiety disorders. For example, the Yale–Brown Obsessive–Compulsive Scale (generally considered to be the gold standard assessment tool for obsessive–compulsive disorder) is not mentioned, nor are other important scales reviewed (e.g., Anxiety Sensitivity Index, Penn State Worry Questionnaire). Instead, regardless of the problem being assessed, most of the chapters tend to recommend using general measures of anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory) and personality disorders (Structured Clinical Interview for DSM-IV Personality Disorders). Some other measures recommended are either no longer the most current version (e.g., the Anxiety Disorders Interview Schedule, Revised, which is based on DSM-III-R criteria and has since been revised) or have been shown to have limited validity for measuring anxiety (e.g., State-Trait Anxiety Inventory).
Despite these limitations, Treatment Plans and Interventions for Depression and Anxiety Disorders is an excellent resource, filled with useful information that no clinician should be without. I highly recommend it for new therapists and students, as well as for experienced clinicians.
Martin M. Antony, PhD, C Psych
Hamilton, Ontario, Canada