Cognitive-Behavioral Therapy for Anxiety Disorders: Mastering Clinical Challenges


Helping Therapists Bring about Enduring Change when Treating clients with any Anxiety Disorder, this invaluable book combines expert guidance, in-depth exploration, and innovative clinical strategies. The authors draw on extensive experience and research to provide a framework for constructing lucid formulations of complex cases. They identify obstacles that frequently arise during the early, middle, and later stages of treatment and present a wide range of practical solutions. The volume demonstrates clear-cut ...

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Helping Therapists Bring about Enduring Change when Treating clients with any Anxiety Disorder, this invaluable book combines expert guidance, in-depth exploration, and innovative clinical strategies. The authors draw on extensive experience and research to provide a framework for constructing lucid formulations of complex cases. They identify obstacles that frequently arise during the early, middle, and later stages of treatment and present a wide range of practical solutions. The volume demonstrates clear-cut yet flexible ways to enhance client engagement, foster metacognitive awareness, facilitate emotional processing, address low self-esteem and fear of uncertainty, and much more.

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Editorial Reviews

Journal of Psychosomatic Research

"Provides practical and user-friendly guidelines for clinicians in their daily work....A valuable resource for clinicians in training in advanced CBT strategies and is a notable attempt to advance a transdiagnostic approach to treating anxiety disorders that provides a snapshot of where the field is heading next."--Journal of Psychosomatic Research
Journal of Behavioural and Cognitive Psychotherapy

"Each chapter constructs a golden bridge between science and practice. The authors identify the important components of treatment at each phase, while explicating the theoretical and empirical framework within which each component of treatment is grounded. Their knowledge of the literature on the development and persistence of anxiety disorders is current and impeccable. Large bodies of findings are distilled into accurate summations that readily inform practice. The authors draw upon their collective expertise in treatment to describe a myriad of strategies the clinician can use to meet the goals of each treatment component. Well-written, concise, and centered on rich case examples, these descriptions effectively communicate how to implement CBT techniques in a truly compassionate and collaborative manner....This book empowers the clinician with the knowledge required to develop a solid case formulation and exercise good clinical judgment in the implementation of the rich variety of therapeutic techniques described. This book is an invaluable resource for the clinician, the CBT trainee, and the CBT instructor."--Journal of Behavioural and Cognitive Psychotherapy
From the Publisher

"This long-awaited book exceeds expectations. It provides a single, comprehensive guide to CBT for anxiety disorders, from assessment to termination. This is no small feat in itself, and yet, Butler et al. also offer so much more. Therapists will appreciate the sophisticated nuances of therapy depicted here. Layers of clinical creativity are embedded within illustrative case examples. As an added bonus, the authors' transdiagnostic approach offers a clear path through the sometimes confusing process of treating clients with multiple anxiety disorders. I heartily recommend this elegant book, whether it is the first or the 50th that you read on anxiety treatment."--Christine A. Padesky, PhD, cofounder, Center for Cognitive Therapy, Huntington Beach, California

"Cognitive-Behavioral Therapy for Anxiety Disorders is a refreshing alternative to many of the existing manuals on this topic. It presents a highly individualized, formulation-based, cognitive approach to treating these challenging conditions. The book is well grounded in science and includes solutions to the most common treatment roadblocks. I highly recommend it to anyone who works with people who suffer from anxiety disorders."--Martin M. Antony, PhD, ABPP, Professor and Director of Graduate Studies, Department of Psychology, Ryerson University, Toronto, Canada

"This book must be read by all those who seek to help people suffering from anxiety disorders. It clearly and accessibly portrays the essence of effective CBT for anxiety while avoiding oversimplified prescriptions. The book is unique in helping clinicians to achieve the integration of clinical art and clinical science that characterizes excellent CBT. The reader will learn essential therapeutic skills for striking a balance in two key areas: between general and specific factors in anxiety disorders and their treatment, and between self-acceptance and recognizing and implementing the need for change. Read this book and use it!"--Paul Salkovskis, PhD, CPsychol, Institute of Psychiatry, King’s College, London, and Clinical Director, Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust

Bulletin of the Menninger Clinic

"Therapists who have some experience using CBT in practice will find it useful in learning how to circumvent common stumbling blocks and use CBT in situations novel to them. The book does a nice job in using theory, evidence, and clinical experience to enhance practice. It is a useful work for clinicians working to hone their CBT skills."--Bulletin of the Menninger Clinic
Cognitive Behavioral Therapy Book Reviews

"I would love to have had [this book] available to me when I first attempted to treat people with anxiety disorders as a trainee in the 1970s, and I would urge anyone new to the field, as well as more experienced practitioners, to obtain a copy....Provides one of the best accounts I have read of how to get the most out of therapist-guided, in-session behavioral experiments, including their use to enrich the formulation, to detect subtle safety-seeking behaviors that maintain the problem and prevent patients from disconfirming their fears, and to promote experiential learning."--Cognitive Behavioral Therapy Book Reviews
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Product Details

Meet the Author

Gillian Butler, PhD, an Associate of the Oxford Cognitive Therapy Centre, is a Fellow of the British Psychological Society and a Founding Fellow of the Academy of Cognitive Therapy. She has conducted research on CBT for anxiety disorders and has a special clinical interest in the use of CBT during recovery from childhood trauma. Dr. Butler is the author of Overcoming Social Anxiety and Shyness, Manage Your Mind: The Mental Fitness Guide, Psychology: A Very Short Introduction, and other books. With colleagues from the Oxford Cognitive Therapy Centre (including Melanie Fennell and Ann Hackmann), she is a coeditor of the Oxford Guide to Behavioural Experiments in Cognitive Therapy.

Melanie Fennell, PhD, is Director of the University of Oxford Diploma/MSc in Advanced Cognitive Therapy Studies and is a research therapist in Oxford's Department of Psychiatry. She will also codirect a new Master of Studies in Mindfulness-Based Cognitive Therapy program. Dr. Fennell has contributed to the development of treatment protocols for depression and for a range of anxiety disorders, and has published widely on CBT for depression and low self-esteem. In 2002, she was voted "Most Influential Female UK Cognitive Therapist" by the membership of the British Association of Behavioural and Cognitive Psychotherapies.

Ann Hackmann, PhD, is a Consultant Clinical Psychologist at the Oxford Cognitive Therapy Centre and the Department of Psychiatry, University of Oxford. She has worked for over 20 years in a research group that specializes in the development of cognitive therapy protocols for anxiety disorders. Working with imagery in cognitive therapy is her special interest, and she has published widely on this topic. Dr. Hackmann has provided teaching and training in cognitive therapy in many national and international settings, and is a Founding Fellow of the Academy of Cognitive Therapy.

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Table of Contents

Part I Setting the Scene 1

1 Treating Anxiety Disorders: The State of the Art 3

Cognitive Therapy and Anxiety 3

A Transdiagnostic View of Underlying Cognitive and Behavioral Processes 5

Current Models and Protocols 7

Embracing Complexity While Utilizing Specific Protocols 21

Conclusion 23

Part II Deepening Understanding and Securing Engagement 27

2 Assessment: Investigating Appraisals in Depth 29

Standard Methods of Accessing Appraisals 30

Targeting Higher Level Appraisals 31

Input from Memory in the Anxiety Disorders 34

How Should We Access "Hot Cognitions"? 39

Conclusion 46

3 Case Formulation: Making Sense of Complexity 48

Principles Guiding Case Formulation 49

Applying these Principles to Resolve Problems in Formulation 49

Anxiety Disorders and Formulation Work: Mapping the Territory 52

Judging the Quality of a Case Formulation 54

Using Metaphors, Pictures, and Diagrams in Formulation Work 56

Formulating Interactions between People 60

Formulating Comorbidity with Different Kinds of Anxiety 61

Conclusion 70

4 Decentering from Thoughts: Achieving Objectivity 71

The Metacognitive Perspective 72

Aspects of Cognitive Therapy That Enhance Metacognitive Awareness 72

Specific Methods for Enhancing Metacognitive Awareness 75

Conclusion 84

Part III Facilitating Emotional Processing 85

5 Bringing About Lasting Change at the Deepest Level 87

Emotional Processing 87

Spontaneous Cognitive Change as a Result of Simply Evoking Hot Material 88

Using Traditional Cognitive Therapy Techniques to Prompt for Change, by Holding Old Material in Mind While Accumulating More Information 90

Using the Properties of Imagery to Bring About Cognitive Change 93

Unpacking and Transforming Metaphorical Images 98

Conclusion 104

6 The Role of Behavioral Experiments 106

The Role of Behavior in Maintaining Anxiety 108

Behavioral Interventions in Treatment 109

Behavioral Experiments and Experiential Learning 111

Creating Successful Behavioral Experiments: The Practicalities 113

Alan's Behavioral Experiments: A Clinical Example 116

Maximizing the Impact of Behavioral Experiments 121

Therapist-Guided In-Session Experiments 126

Conclusion 127

Part IV Overcoming Three Major Obstacles to Progress 131

7 Avoidance of Affect 133

Transdiagnostic Features of Avoidance of Affect 135

The Meaning of Affect 136

Recognizing Avoidance of Affect 137

Making Sense of Avoidance of Affect: Theories, Causes, and Consequences 138

Strategies for Dealing with Avoidance of Affect 142

Pitfalls and Difficulties 150

Conclusion 151

8 Low Self-Esteem 153

A Cognitive Perspective 154

The Relationship between Anxiety and Low Self-Esteem 154

A Cognitive Model of Low Self-Esteem 156

The Role of Rules for Living 159

How the Bottom Line Is Triggered 160

How Low Self-Esteem Is Maintained 160

Treating Comorbid Anxiety and Depression: A Case Example 161

Applying the Model 164

Interventions Designed to Enhance Self-Esteem 166

Questioning the Bottom Line: Undermining the Evidence 168

Creating a New Bottom Line 169

Conclusion 173

9 Dealing with Uncertainty 174

Making Sense of Anxiety and Uncertainty 174

Anticipating and Avoiding Common Pitfalls 176

Strategies Based on Standard Applications of Cognitive Therapy 178

Acknowledging That Change Involves Taking Risks 180

Strategies Derived from the Treatment of GAD 181

Practical Tips 184

Strategies for Helping People to Live with Uncertainty 187

Conclusion 190

Part V Ending Treatment Productively 193

10 Creating a Therapy "Blueprint" 195

The Processes Involved in Ending Treatment 196

A Personal Blueprint for Treating Anxiety Disorders 207

References 209

Index 218

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