Cognitive Therapy of Anxiety Disorders: Science and Practice by David A. Clark
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AboutCognitive Therapy of Anxiety Disorders: Science and Practice by David A. Clark
The intricacies of anxiety have continued to capture the attention of some of the world’s greatest scientists, scholars, and critical thinkers. In 1953 Rollo May stated in Man’s Search for Himself that the “middle of the twentieth century is more anxiety-ridden than any period since the breakdown of the Middle Ages” (p. 30). If this statement characterized the last century, is it not even more applicable to the dawn of the 21st century with all the social, political, and economic threats that besiege us?
Despite an end to the cold war, an era of relative global stability and cooperation, and an unprecedented rise in economic prosperity and technological advances, many in the Western world live in a state of perpetual threat and uncertainty. According to the National Institute of Mental Health (2003), approximately 40 million American adults (18%) suffer from an anxiety disorder, with serious mental illness, including anxiety disorders, costing an estimated $193 billion in lost personal earnings (Kessler et al., 2008). No wonder the search for highly effective and accessible treatments for anxiety disorders has become a major health initiative for most developed countries.
Twenty-five years ago, coauthor Aaron T. Beck published Anxiety Disorders and Phobias: A Cognitive Perspective with Gary Emery and Ruth Greenberg. In the first part of that book, Beck introduced a cognitive model of anxiety disorders and phobias that represented a significant reconceptualization of the etiology, nature, and treatment of anxiety (Beck, Emery, & Greenberg, 1985).
At that time, research on the cognitive features of anxiety was scant, and so much of the theoretical scaffolding was, by necessity, based on clinical observation and experience. Since key aspects of the cognitive model of anxiety had not yet been investigated, some of the treatment recommendations described in the second half of the book have not stood the test of time.
However, the last 20 years have witnessed a virtual explosion in basic information-processing research on the cognitive model of anxiety, the development of disorder-specific cognitive models and treatment protocols for major anxiety disorders, and dozens of treatment outcome studies demonstrating the efficacy of cognitive therapy of anxiety.
In light of the unprecedented advances in our understanding and treatment of the cognitive basis of anxiety, a comprehensive, updated, and reformulated presentation of the cognitive model of anxiety was needed so the model could be understood within the context of contemporary research findings. This book, then, was born out of this necessity. In addition, we believe that a single volume containing a detailed comprehensive treatment handbook for cognitive therapy is timely in order to encourage greater use by clinicians of evidence-based psychotherapy for anxiety disorders.
The book is divided into three parts. Part I consists of four chapters on the reformulated cognitive model of anxiety and its empirical status. Chapter 1 discusses the distinctions between fear and anxiety and provides a rationale for taking a cognitive perspective on anxiety. Chapter 2 presents a reformulation of the generic cognitive model of anxiety based on the original model (Beck et al., 1985) that was later refined by Beck and Clark (1997).
Twelve key hypotheses of the model are presented in Chapter 2, and the vast empirical research relevant to these hypotheses is critically reviewed in Chapters 3 and 4. The literature review spans hundreds of studies conducted in key research centers in Western Europe and North America, confirming our perception that the main tenets of the cognitive model of anxiety have achieved a broad basis of empirical support.
The cognitive therapy approach has been applied to a wide range of psychiatric and personality conditions. Thus, Part II consists of three chapters that explain how the basic elements of cognitive therapy are used to alleviate anxiety. Chapter 5 reviews several standardized measures of anxious symptoms and cognition that are useful for assessment and treatment evaluation and provides a detailed explanation for producing a cognitive case formulation of anxiety.
Chapters 6 and 7 present a step-by-step description for implementing various cognitive and behavioral intervention strategies for the reduction of anxious symptoms. Case illustrations suggested therapy narratives, and clinical resource materials are provided in all three chapters as training tools in cognitive therapy.
The final section, Part III, consists of five chapters that present disorder-specific adaptations of cognitive therapy for panic disorder, social phobia, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. We excluded specific phobias because there have been fewer developments on the cognitive aspects of phobia since its presentation in Beck et al. (1985), and exposure-based treatment is still considered the main treatment approach for the reduction of phobic responses.
Each of the disorder-specific chapters presents a cognitive model tailored to that disorder and a review of the empirical research that addresses key hypotheses of each model. In addition, the chapters offer disorder-specific case conceptualizations and cognitive therapy strategies that target unique symptom features of each disorder. In essence, Part III consists of five mini treatment manuals for complex anxiety disorders.
To assist therapists in explaining cognitive concepts and strategies to their clients, we are in the process of developing a companion client workbook that will match the organization and themes of the present book and will offer explanations for key aspects of the therapy, homework exercises, and record-keeping forms.
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