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

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ISBN13: 978-0-471-96474-2 (HB)
ISBN13: 978-0-471-96476-6 (PB)

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 19891990 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.

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.

The first chapters (14) 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 presented first and more advanced and complex concepts and strategies evolve as the work progresses. It is also written to reduce redundancy in the presentation of strategies across chapters. Each disorder chapter focuses on the application of some of the most useful techniques for the specific disorder under consideration. Nevertheless, many of the techniques reviewed in earlier chapters should be considered. In this way the book presents a comprehensive coverage of a wide range of cognitive therapy case conceptualisations and techniques.

The panic disorder chapter follows the influential cognitive theory and treatment developed by David M. Clark, and colleagues. The hypochondriasis chapter follows the theory and treatment developed by Paul Salkovskis, David Clark, Hilary Warwick and colleagues. These chapters contain some new material devised by the author. The rest of the book is based on the authors theoretical, research and practical experience.

While this book offers a comprehensive guide to cognitive therapy of anxiety, appropriate training and continued supervision by appropriately trained therapists are essential for the development of effective cognitive therapy skills. It is recommended that therapists should attend recognised workshops and pursue cognitive therapy training at centres that offer suitable courses.

Adrian Wells

There is no single cognitive theory or model of anxiety disorder. This book focuses primarily on the approach of Beck and allied approaches, which are among the most influential and are supported by data from rigorous experiment and self-report studies. Since the concept of cognition is central in this volume it is necessary to define what is meant by this term in the present context. In its broadest sense cognition refers to the full range of processes and mechanisms that support thinking, and also the content or products of these processes, namely thoughts themselves. The basic premise of cognitive theories of emotional disorder is that dysfunction arises from an individuals interpretation of events. Moreover, behavioural responses emerging from particular interpretations are also important factors involved in the maintenance of emotional problems.