Cognitive Therapy of Anxiety Disorders: A Practice Manual and Conceptual Guide

346 Pages·1997·4.04 MB·English

by  Adrian Wells

CONTENTS
ABOUT THE AUTHOR
PREFACE
1. COGNITIVE THEORY AND MODELS OF
ANXIETY: AN INTRODUCTION
COGNITIVE THEORY OF ANXIETY DISORDERS
SUMMARY OF THE GENERAL SCHEMA THEORY
EVIDENCE FOR THE SCHEMA THEORY OF ANXIETY
A QUESTION OF CAUSALITY
FROM SCHEMA THEORY TO DISORDER-SPECIFIC
MODELS
OVERLAPPING AND DISTINCT CONSTRUCTS
CONCLUSION
2. ASSESSMENT: AN OVERVIEW
AIMS OF ASSESSMENT
RECOMMENDED ADDITIONAL MEASURES FOR
SPECIFIC DISORDER
SPECIFIC RATING SCALES
COGNITIVE THERAPY ASSESSMENT INTERVIEW
STRUCTURE OF THE ASSESSMENT INTERVIEW
MULTIPLE PRESENTING PROBLEMS
CONCLUSION
3. COGNITIVE THERAPY: BASIC
CHARACTERISTICS
COGNITIVE TECHNIQUES
BEHAVIOURAL TECHNIQUES
THE STRUCTURE OF THERAPY
SESSION STRUCTURE
THE FIRST TREATMENT SESSION
THE PROCESS OF THERAPY: ESSENTIAL BASICS
CONCLUSION
4. COGNITIVE THERAPY: BASIC TECHNIQUES
ELICITING NEGATIVE AUTOMATIC THOUGHTS
REATTRIBUTION METHODS
BEHAVIOURAL REATTRIBUTION
SAFETY IN TREATMENT
ELICITING ASSUMPTIONS
CONCLUSION
5. PANIC DISORDER
CHARACTERISTICS OF PANIC ATTACKS
COGNITIVE MODEL OF PANIC
FROM COGNITIVE MODEL TO CASE
CONCEPTUALISATION
DERIVING THE VICIOUS CIRCLE
DEVELOPING THE BASIC CONCEPTUALISATION:
INCORPORATING SAFETY BEHAVIOURS AND
AVOIDANCE
SOCIALISATION
REATTRIBUTION STRATEGIES
BEHAVIOURAL EXPERIMENTS
VERBAL REATTRIBUTION TECHNIQUES
DEALING WITH AVOIDANCE
RELAPSE PREVENTION
EXAMPLE TREATMENT OUTLINE
6. HYPOCHONDRIASIS: HEALTH ANXIETY
A COGNITIVE MODEL OF HYPOCHONDRIASIS
GENERAL TREATMENT ISSUES
FROM COGNITIVE MODEL TO CASE
CONCEPTUALISATION
SOCIALISATION
REATTRIBUTION STRATEGIES
BEHAVIOURAL EXPERIMENTS
VERBAL REATTRIBUTION TECHNIQUES
IMAGERY TECHNIQUES
DEALING WITH HEALTH-RISK BEHAVIOUR
CONCLUSIONS
EXAMPLE TREATMENT OUTLINE
7. SOCIAL PHOBIA
THE NATURE OF SOCIAL PHOBIA
A COGNITIVE MODEL OF SOCIAL PHOBIA
FROM COGNITIVE MODEL TO CASE
CONCEPTUALISATION
SOCIALISATION
SEQUENCING OF TREATMENT INTERVENTIONS
MODIFYING SELF-PROCESSING
VERBAL REATTRIBUTION
BEHAVIOURAL EXPERIMENTS
WORKING WITH CONDITIONAL ASSUMPTIONS AND
BELIEFS
CONCLUSIONS
EXAMPLE TREATMENT OUTLINE
8. GENERALISED ANXIETY DISORDER
THE NATURE OF WORRY
A COGNITIVE MODEL OF GAD
ELICITING INFORMATION FOR
CONCEPTUALISATION
FROM COGNITIVE MODEL TO CASE
CONCEPTUALISATION
SOCIALISATION
MODIFYING META-WORRY AND NEGATIVE BELIEFS
VERBAL REATTRIBUTION
BEHAVIOURAL EXPERIMENTS
MODIFYING POSITIVE BELIEFS ABOUT WORRY
MODIFYING COGNITIVE BIAS
STRATEGY SHIFTS
THE PROBLEM OF CO-MORBIDITY
CONCLUSION
EXAMPLE TREATMENT OUTLINE
9. OBSESSIVE-COMPULSIVE DISORDER
PREVALANCE OF OBSESSIONS AND COMPULSIONS
COGNITIVE MODELS OF OCD
A GENERAL WORKING MODEL
DEVELOPING A CASE FORMULATION
CONCEPTUALISATION INTERVIEW: A CASE
EXAMPLE
SOCIALISATION
GENERAL AIMS OF COGNITIVE THERAPY
VERBAL REATTRIBUTION
BEHAVIOURAL REATTRIBUTION
ADDITIONAL CONSIDERATIONS
CONCLUSION
EXAMPLE TREATMENT OUTLINE
10. FUTURE DEVELOPMENTS IN COGNITIVE
THERAPY
THE SELF-REGULATORY EXECUTIVE FUNCTION
MODEL
TREATMENT IMPLICATIONS OF THE S-REF MODEL
META-COGNITION AND ANXIETY DISORDER
OBSESSIONAL PROBLEMS
SUMMARY AND CONCLUSION
RATING SCALES
PANIC RATING SCALE (PRS)
SOCIAL PHOBIA RATING SCALE (SPRS)
HEALTH-ANXIETY RATING SCALE (HRS)
GENERALISED ANXIETY DISORDER SCALE (GADS)
APPENDIX
REFERENCES
INDEX

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ABOUT THE AUTHOR
Adrian Wells is currently appointed as Senior Lecturer in Clinical Psychology
and Consultant in the Department of Clinical Psychology at the University of
Manchester. He is a leading cognitive therapist with an international reputation
in the field. After receiving his PhD in 1987 he subsequently trained in clinical
psychology. He was a post-doctoral fellow at the Center for Cognitive Therapy
Philadelphia for the year 1989–1990 where he received his diploma in cognitive
therapy from Aaron T. Beck. For the next five years he worked as Senior
Research Clinical Psychologist at the University of Oxford Department of
Psychiatry. There he collaborated with the Oxford Cognitive Therapy group in
the development and evaluation of cognitive therapy of anxiety. He has been
extensively involved in the training and supervision of cognitive therapists both
nationally and internationally, and is the author of numerous published works on
cognitive theory and treatment.
PREFACE
There were two broad aims in writing this book. The first was to produce a
comprehensive practical text of cognitive therapy of anxiety disorders. In order
for a treatment guide to be of most value it should offer a detailed description of
not only what to do in treatment but also an account of how to do it. This book
does both. Through detailed analysis it has been possible to develop for the first
time specific protocols of how to implement a range of basic and advanced
cognitive modification procedures. The book is illustrated throughout with case
examples and examples of therapeutic dialogues. All of the material used is
based on actual cases.
Cognitive therapy represents many things to many clinicians. Often what
clinicians do in treatment is determined by what their experience tells them
should be effective. However, the principle on which this book is based is that if
cognitive therapy is to advance and become increasingly effective in the hands
of a range of therapists we need to develop a cognitive therapy of greater
theoretical integrity. More specifically, the techniques used in treatment should
be derived from a specific cognitive conceptualisation of a problem.
The second aim of this work, therefore, was to present a pure approach to
cognitive therapy that makes a significant contribution to advancing theory and
practice. The link between theory and practice and the influence of new ideas in
‘cognitive therapy’ is a recurrent theme. The practice of ‘cognitive therapy’
ranges from the more eclectic applications to more purist approaches in health
settings; this book argues for a purer form of cognitive therapy.
Structure of the book
The first chapters (1–4) of the book present a background to cognitive theory of
anxiety disorders and an overview of assessment. The nature of cognitive
therapy, and basic techniques are presented in Chapters 3 and 4. The first four
chapters are indispensable reading and even experienced cognitive therapists
should find new information here. The individual disorder chapters present
detailed descriptions of the use of specific conceptualisations and strategies in
treatment.
The book is written in a particular sequence so that fundamental skills are