Review of Cognitive therapy of anxiety disorders: Science and practice.

Abstract

Cognitive Therapy of Anxiety Disorders: Science and Practice, by David A. Clark & Aaron T. Beck (Editors). Guilford Press, 2009, 628 pages (ISBN 978-1-60623-434-1, CA $71.50, Hardcover) Reviewed by MELISA ROBICHAUD DOI: 10.1037/a0021517 Drs. Clark and Beck's book Cognitive Therapy of Anxiety Disorders: Science and Practise is a comprehensive review of cognitive therapy for anxiety from its empirical theoretical foundation to its clinical application to disorders. Although the focus of the text is ultimately on the cognitive treatment of anxiety, the rich theoretical background that is interwoven throughout makes this book of interest to academics and graduate students as well as clinicians. The book is divided into three parts, each with several chapters: 1) cognitive theory and research on anxiety; 2) assessment and intervention techniques used in cognitive therapy for anxiety; and 3) the application of cognitive therapy to specific anxiety disorders (e.g., panic disorder, obsessive- compulsive disorder [OCD]). The first section covers a number of diverse yet interrelated areas with respect to anxiety, its origins in research, and its relationship to cognitive theory. The authors include a discussion on the theoretical and practical discrimination between the constructs of fear and anxiety, research findings on the epidemiology, prevalence, and comorbidity of anxiety, as well as the various theories for the development of anxiety. With respect to the latter, biological, behavioural, and cognitive conceptualizations are presented, with the authors making the for cognitive theory through a presentation of the central tenets of the theory. The empirical status of these contentions is demonstrated through a review of bom early seminal research on anxiety and current studies in basic experimental, information-processing, and clinical research. Finally, the aumors discuss research on constructs identified as vulnerability factors to the development of anxiety. Although there is a strong emphasis on the empirical background of cognitive theory to anxiety in this section, the authors have done a commendable job of consistently integrating clinical utility into the book. For example, in every chapter including those in this first section, Clinician Guidelines are presented that tie me topic under discussion to its meaning from a clinical perspective. A good example of this is me description of the biological aspects of anxiety, which includes a review of genetic factors, neurophysiology, and neurotransmitters. Although a necessary component in the broader understanding of anxiety, this section might potentially be of limited interest to practising clinicians. However, clinical guidelines presented here include the importance of querying for the presence of anxiety in first-degree relatives during assessment, and the provision of psychoeducation regarding the role of higher-order cortical centers of the brain in reasoning and judgment and the cognitive treatment goal of overriding subcortical emotional brain structures to reduce the subjective experience of anxiety. Although some of these clinician suggestions may not always be of primary relevance for actual clinical use, the tie between science and its application is nicely illustrated. The second part of the book covers the assessment of dysfunctional anxiety and provides a review of cognitive and behavioural interventions used in cognitive therapy for anxiety. The assessment section is very detailed, covering diagnostic measures and symptom questionnaires, as well as processes involved in the development and maintenance of anxiety that will assist in the creation of a comprehensive case formulation. There are a number of selfmonitoring sheets and psychoeducation handouts for clients included in fhis section, as well as quick reference guides for use by clinicians to assist in assessment and the development of a client case formulation. …