Review of Clinician's guide to PTSD: A cognitive-behavioural approach.

Abstract

STEVEN TAYLOR Clinician's Guide to PTSD: A Cognitive-Behavioural Approach New York: Guilford, 2007, 322 pages (ISBN: 1593853262, C$35.00, Hardcover) Reviewed by REGAN SHERCLIFFE Post-traumatic Stress Disorder (PTSD) has been brought to the attention of the general public as the result of a combination of events, including the recovered memory debate, Rwanda, the aftermath of residential schools, the attack on the World Trade Center and the subsequent wars in Afghanistan and Iraq, and the increase in the number of insurance claims and litigations related to trauma. Treating people with PTSD is a challenging and difficult enterprise, which is no surprise to those who work with traumatized individuals. There is an abundance of literature available on the topic of PTSD, but even a casual perusal of that literature can leave one with a sense of being overwhelmed by the many seemingly disparate theories regarding predisposing factors, comorbidity, etiology, and importantly, what constitutes an effective empirically based treatment program. Steven Taylor takes on the lofty challenge of summarizing the research on PTSD as it relates to assessment and treatment in his book, Clinician's Guide to PTSD: A Cognitive Behavioral Approach. Consistent with the literature on PTSD, there are several books available to clinicians that mirror the state of the research and as such, do little to help synthesize the research into a practical and pragmatic tool for clinicians. Taylor's book is, thankfully, not one of those books. The Clinician 's Guide to PTSD is a concise yet thorough examination of the research related to treating traumatized individuals. The result is a timely, well written, and accessible book that will be a valuable resource to clinicians who treat people with PTSD. The book is divided into two sections: conceptual and empirical foundations, and treatment methods and protocols. The first section is essentially a review of the literature and the first chapter includes reviews of the DSM-IV definition of PTSD, the economics of PTSD, and epidemiology. What is particularly helpful is that Taylor expands on the DSM definition of PTSD by examining in a comprehensive manner the research on the specific symptoms and clusters of symptoms, and he augments the research with clinical examples. Also included in the first section is a particularly informative chapter that discusses the cognitive features of PTSD combined with a review of four cognitive theories of PTSD. Each of the cognitive theories of PTSD attempts to provide a comprehensive account for why it is that certain individuals develop PTSD when others who experience similar events do not, and each model also attempts to explain factors that maintain the symptoms. Taylor reviews each theory and then comments on the utility of the theories; parsimony is one criterion the book uses to judge each of the four theories reviewed. The use of parsimony is an interesting choice as what becomes clear (especially considering the section on risk factors for PTSD) is that the reasons why people develop PTSD are complex, and as Taylor points out, there are few well-tested comprehensive theories. Obviously, choosing a theory is important in die context of treatment and Taylor states in the book that he relies primarily on the work of Ehlers and Clark, which is the most complex and thorough of the theories presented, to inform his treatment model. The reviews of the cognitive factors/theories associated with the development and maintenance of PTSD are reason enough to read this book. In the first section of the book, Taylor includes a chapter on the neurobiology of fear and stress, and he reviews several of the better-known theories such as the hypothalamic-pituitary-adrenal model, and he also reviews the research on neurotransmitters, genetics, and brain structures in the context of PTSD. Also included in the chapter is a section that reviews the literature on tonic immobility as an evolutionary response to being attacked. …