Abstract
This book is in the style of other ‘guides’ to cognitive behaviour therapy (CBT) on the market, but its detailed focus on the role of CBT in the setting of coping with chronic medical problems means that it makes a useful contribution to the literature. It is a practical, clinically orientated text with case examples and illustrative transcripts of patient-therapist exchanges. It is aimed at clinicians who already have some experience in using CBT techniques. It would be of interest to psychologists and psychiatrists, but may also be of interest to general practitioners and physicians interested in applying CBT techniques.
In my view this is a ‘how’ CBT book more than a ‘why’ CBT book. The book makes a good case for why psychological interventions for the chronically medically ill are ever more relevant, including higher expectations of cure, more debilitating and demanding treatments, and foreshortened hospital stays. However, when arguing why CBT, in particular, is appropriate in this clinical setting, a less satisfying justification is used: ‘The current UK health service emphasis on patients having access to evidence-based and cost-effective treatments should make it more likely that patients will be able to access CBT’. The author then admits there is currently only evidence for CBT's role in the areas of cancer and chronic pain.
The book gives a practical and clinically orientated approach to chronically medically ill patients, but the patients described as unsuitable for CBT by the book would comprise, in my experience, a sizeable proportion of referrals of chronically medically ill patients to psychiatrists in both consultation–liaison and private practice. I would agree that they are unsuitable for CBT, but there are other approaches, or combinations of approaches, which might be helpful to such patients. In addition there is little discussion in this text of how to incorporate the CBT approach with concurrent antidepressant therapy which is a commonly encountered clinical situation.
The book describes a clear approach to assessing, formulating and planning CBT treatment strategies. It makes the useful distinction, consistently through the chapters, between problem-level formulation and caselevel formulation.
There are chapters on the role of CBT in cancer, chronic pain, diabetes, dermatology, surgical problems and cardiac problems. The chapter on cancer argues that modern therapy and palliation mean that cancer is very often a chronic illness. The chapters on chronic pain and cardiac problems focus more on managing medically unexplained physical symptoms, the chapter on dermatology emphasizes behavioural aspects of CBT in particular.
Although the author claims that ‘CBT places the meaning-making capacity of patients at the heart of the therapeutic endeavour’, some readers may be troubled by the somewhat mechanistic, here and now, emotionally superficial approach described. This book is not unique among CBT texts in that respect. The symbolic resonations which the patients’ medical misfortunes may have with their personal lives, and the deeper personal significance of their physical frailty or enforced dependency on doctors and the health system are not the focus of this book.
The book, however, delivers what its title suggests and it is clear that the author, a clinical psychologist, is experienced in this field. It provides relevant summaries of the literature in each area it tackles, it is also well referenced and gives some useful inventories and questionnaires in full.