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Clinical Handbook of Psychological Disorders. David H. Barlow (2014) New York: The Guilford Press. pp. xi–768.

Michalopoulou, Georgia PhD

The Journal of Nervous and Mental Disease: February 2015 - Volume 203 - Issue 2 - p 156
doi: 10.1097/NMD.0000000000000255
Book Reviews

Associate Professor, Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI.

In the field of mental health, where there is a plethora of books on the treatment of psychological disorders, David Barlow’s Clinical Handbook of Psychological Disorders is an indispensable guide replete with clinical tools for new and seasoned clinicians, as well as an excellent teaching resource.

The purpose of the book, now in its fifth edition, is to present state-of-the-art, evidence-based treatments supported by cutting-edge advancements in the understanding of the most frequently encountered psychological disorders in adults.

The authors, all distinguished scholars and clinical investigators, have addressed a wide range of psychological disorders in a rigorous and empirical manner, skillfully translating what is known about them, from theory and precisely executed research to clinical application. This book presents the most advanced treatment protocols in a detailed manner from assessment to treatment completion.

The handbook is composed of 18 well-organized chapters constructed in a fairly uniform format, enhancing the book’s utility and teaching value. Each chapter is dedicated to one disorder and presents a systematic review of background knowledge, most recent literature, a disorder’s theoretical framework and conceptualization, application of treatment, and discussion of the therapeutic relationship, including patient and therapist characteristics influencing the therapeutic process. Pharmacologic treatments are also reviewed, along with empirical evidence and comparative studies. The chapters conclude with vivid case illustrations and therapy transcripts. The fine-grained analysis of each disorder; discussion of cognitions, emotions, and behaviors that maintain it, and the clear identification of treatment targets allow the reader to develop an in-depth understanding of the relationship between treatment goals, therapeutic techniques, and theoretical model.

Clients’ and therapists’ characteristics, personal and cultural, as well as therapist-client relationship elements have found the attention they deserve in many chapters in the handbook. This is especially evident in Chapter 15, Evidence-Based Relationships and Responsiveness for Depression and Substance Abuse, where clients’ characteristics are weaved into the assessment and treatment protocol, highlighting the importance of the client’s context, cultural identities, and background and the influence of these factors on treatment and clinical outcomes.

When one looks at this book from the point of view of a practicing clinician, the most valuable aspect by far is the detailed account of the execution of treatment. Transcripts depict all aspects of treatment and clinical interaction from the initial session to termination; no aspect of the treatment remains unexplored or uncovered. The clinician rewards from each well-written chapter are several: a clear understanding of all facets of the disorder (etiology, manifestation, maintenance of maladaptive behaviors) and acquaintance with tools such as sample worksheets that equip the clinician to implement the treatment protocol.

The book includes a combination of existing, well-known, evidence-based therapies that have been refined and updated to reflect new advancements in knowledge and new protocols that are supported by strong evidence for their lasting effectiveness.

Chapter 7, Cognitive Treatment for Depression, is an example of how Young, Rygh, Weinberg, and Beck, leading authorities in the treatment of depression, provide an update of the well-known and widely used cognitive therapy for this disorder. The new elements center on an expansion of “schema theory,” which posits that the development of maladaptive core schemas early in life, which result from the interaction between a child’s temperament and early negative life experiences, is an important predisposing factor in patients with chronic or severe depression. The authors’ illustrations of both the traditional cognitive therapy model for a nonchronic patient and the schema-focused protocol with a chronically depressed patient artfully elucidate the basic concepts that guide treatment and the targets for intervention.

A highly generalizable treatment protocol, the “Unified Transdiagnostic Protocol for Emotional Disorders,” is a significant contribution to the collection of treatments included in this book. This protocol departs from the traditional Diagnostic and Statistical Manual of Mental Disorders categorical approach to provide a novel and useful way to conceptualize disorders of emotion and define goals for intervention. Drawing from a growing body of research, this intervention centers its principles in evidence supporting temperamental commonalities in the etiology of emotional disorders and theorizes that a biological predisposition when lined up with a psychological predisposition in the presence of stress has the potential to generate anxiety and mood disorders (p. 239). Considering the high rate of comorbidity in patients with anxiety and mood disorders, the value of this protocol is its applicability across a broad range of disorders that present with emotional dysregulation.

A novel contribution to the handbook’s collection of evidence-based treatments is the Acceptance-Based Behavioral Therapy protocol, Chapter 5. Based on a detailed theoretical model derived from extensive research, the protocol targets three well-defined areas for intervention, which aim to assist patients through psychoeducation and mindfulness exercises to reshape the way they relate to internal experiences, increase acceptance of these experiences, and engage actively in personally valued behaviors to lead a meaningful life.

Charts, forms, and resource references provided in some chapters contribute greatly to the dissemination of clinical material and make application of the techniques easily accessible. Although complete workbooks related to treatment protocols are cited in many instances, additional compilation of core materials for the treatments presented would have been an additional strength of this handbook. The authors may consider making a complete set of the handouts that accompany each protocol or therapy, available as part of future book editions.

In conclusion, this book, continuing with the long tradition of previous editions, is an exceptional resource for clinicians and should be required reading for all in mental health training programs. It has surpassed its stated objectives to provide state-of-the-art scientific knowledge, present empirically tested effective therapies, and teach clinicians how to implement these treatments in a step-by-step manner, helping them achieve the goal that every mental health professional seeks to achieve, that is, to alleviate psychological pain and enable every client to live a more gratifying and fulfilling life.

Georgia Michalopoulou, PhD

Associate Professor

Psychiatry and Behavioral Neurosciences

Wayne State University School of Medicine

Detroit, MI

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DISCLOSURE

The author declares no conflict of interest.

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