Psychological symptoms are widespread and prevalent in primary care. Overall about one quarter of GP consultations are with patients with mental disorders. Cognitive behaviour therapy (CBT) can offer an effective approach to the management of a wide variety of psychological and emotional disorders. Traditionally CBT has involved a series of one hour sessions with patients. However this book sets out to show that CBT can be applied effectively within the 10 minute primary care consultations and gives GPs a framework to do this. This is particularly apt at present as doctors are being encouraged to use non-therapeutic methods for the management of mild and moderate depression. However, the number of health professionals trained in CBT is limited, although there may be increased provision for CBT in locally enhanced services as part of the new GP contract. From this book it is clear that many of the skills involved in CBT are already being used by general practitioners in routine consultations.
There are plenty of useful tables and figures and every few pages there are key summary points. I have to say that on reading the book it is difficult to imagine CBT fitting into a 10 minute consultation. Advice that patients should receive a written record of the discussion may be helpful, but is also likely to be time consuming for the doctor in surgery or outpatients.
There is a section which covers dealing with heartsink patients, and this primarily focuses on dealing with the negative reactions a doctor may be feel towards such a patient. The chapter gives various coping strategies for doctors in this position. The chapter on dealing with depression is very useful. It gives a good background to the aetiology of depression. It questions the approaches that GPs may use to diagnose depression and then covers management including the use of CBT. Sensibly the author recognises that as the availability of CBT is limited a combination of medication and other approaches should be used. There is also a section which covers the use of CBM in physical illness and disability. This primarily concentrates on promoting the patient's independence and enjoyment of life despite the presence of a chronic disease. Many GPs would find this chapter helpful.
Overall I enjoyed reading the book and found it helpful. At times it was a bit repetitive and could perhaps have been a little shorter. After reading this book, even if you are not sold on using cognitive behaviour therapy in consultations, you will have a good awareness of what is involved and this can only be helpful for both the patient and doctor.