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Treatment Plans and Interventions for Depression and Anxiety DisordersReview - Treatment Plans and Interventions for Depression and Anxiety Disorders
(Book with CD-ROM)
by Robert L. Leahy and Stephen J. Holland
Guilford Press, 2000
Review by Terry Burridge
Sep 6th 2000 (Volume 4, Issue 36)

This book is what it says it is--a handbook for treating depression and anxiety disorders. It must also be noted that this is a cognitive handbook, although one of the authors, Stephen Holland, has some background in psychodynamic work. This theoretical undergirding is important because one needs a fair knowledge of cognitive work to be able to make best use of this book. A clinician coming to this work without some idea of how a C.B.T. (cognitive behavioral therapy) approach works will be disadvantaged. With this proviso, the book is very useful. There are eight chapters covering treatment plans for the main neuroses-Depression; Panic Disorders; Agoraphobia; Generalized Anxiety Disorder; Social Phobia; Post Traumatic Stress Disorder; Specific Phobias and Obsessive-Compulsive Disorder. Each chapter begins, helpfully, with a brief review of the literature on the outcomes of various treatment modalities on the topic discussed in that chapter I found this aspect of the book most irritating. Nowhere are non-C.B.T. models offered. So in the chapter on depression various current ideas are expounded as to the causes of depression, viz., depression as absence of rewards, or the inability to obtain rewards. Or it is seen as the result of passive, repetitious, unrewarding behavior. There is no mention of Freud's view of Melancholia or of Klein's Object Relation theories. (But perhaps I am simply carping! The authors did not, after all, set out to offer a comprehensive overview of all the major psychological schools currently offering opinions about treatment options.)

The treatment reviews at the beginning of the chapters are very confident. So, in the chapter on Panic Disorder and Agoraphobia, the authors comment "Outcome studies for cognitive-behavioral treatments of panic disorder and agoraphobia are extremely favorable (75-90% efficacy)". There seems little room for uncertainty here, which in some ways is reassuring. When one first begins working with patients a treatment method offering a 75-90% success rate is very comforting. As time goes by, however, one's caseload seems to consist of that difficult rump of patients who don't get better! At this point Leafy and Holland's book offers no comfort, which is a shame because they are clearly compassionate and competent clinicians who are "out there" in the front line. Perhaps this confidence highlights a major cultural difference between America and the UK. Leafy and Holland are writing from the perspective of private health care where part of the contract seems to be "What's the minimum number of sessions that we the insurance company will have to fund?" So for the clinician there seems to be a need to specify the optimum numbers of sessions that are therapeutically effective. Seen from this perspective one might see the need to be able to say with some certainty, "I can help this person make a fair recovery in x sessions." (It is an interesting point to wonder what private health insurance does for therapeutic optimism. If I know that I can only afford 20 sessions then do I indeed get better within that time frame?)

Let me now go through a chapter in some more detail since this will give a flavor of how the book is put together. The chapter on Depression begins with an overview of symptoms, prevalence and life course; genetic and biological features. It then goes on to offer a C.B.T. understanding of depression. Next comes a brief seven point outline of the treatment program covering Assessment, Socialization to Treatment; Establishment of goals; Behavioral Interventions; Cognitive interventions; Inoculation against future depressive episodes and Phasing out Therapy. A case study is included to demonstrate how this framework can be used in practice. Also included are charts that can be copied and used by the therapist and given to the patient. These charts include a Cognitive, Behavioral, and Interpersonal Assessment of Depression which gives examples of distorted automatic thoughts of the patient and underlying maladaptive assumptions. Then comes a five page Suicide Risk Assessment form that helps the therapist to evaluate their patient's "suicidality" in detail. An excellent handout about depression, which can be given to the patient, follows this. Interleaved between the handouts and charts are detailed interventions and guidelines to help the therapist in their work with a depressed patient. All told, this is typical of the high standard of material in this book.

The final item that comes with this book is a CD ROM containing more information about cognitive interventions; copyable care plans and treatment schemas; information on medication and its benefits.

Add to this the fact that the book is letter-page-size format and one is presented with a formidable amount of information on C.B.T. work with the neuroses. As somebody who is both English and psychodynamically oriented I found some aspects of this book not entirely to my taste. That notwithstanding this book would sit well in any general psychiatric ward, where there are always a number of patients suffering from varying degrees of anxiety and depression. If only some of these interventions are used, then the patients will probably find themselves somewhat helped. And if you are already an enthusiast of C.B.T. as a way of working, then this book really should be on your bookshelf at home.


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