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The Human Nature Review Human Nature Review  2002 Volume 2: 236-238 ( 19 June )
URL of this document http://human-nature.com/nibbs/02/keegan.html

Book Review

Treating Chronic and Severe Mental Disorders: A Handbook of Empirically Supported Treatments
Edited by Stefan G. Hofmann and Martha C. Tompson, (2002). The Guilford Press, New York, 430 pages.

Reviewed by Eduardo Keegan, Professor of Clinical Psychology and Psychotherapies, School of Psychology, University of Buenos Aires, Buenos Aires, Argentina.

Cover Graphic

In his foreword to this book, David Barlow highlights that recent sophisticated multisite clinical trials across a number of child and adult disorders have demonstrated that psychological treatments-sometimes combined with drugs-are as efficacious as other approaches and usually much better in terms of relapse prevention. Since most people seem to prefer learning new coping skills in psychotherapy rather than receiving an equally effective drug treatment if given the choice, this could well be the dawn of a golden age for psychological interventions.

However, the dissemination of these interventions is no mean feat. Only a few specialised centers offer training in these treatments, in contrast to the considerable resources invested in the marketing and dissemination of effective drug interventions.

Treating Chronic and Severe Mental Disorders, edited by Stefan G. Hofmann and Martha C. Tompson, intends to serve as vehicle for the dissemination of psychological interventions for some of the most challenging mental conditions. The clinician will find in it an updated reference on state-of-art psychological treatments for severe-and common-mental disorders.

The book also aims at providing useful information for mental health policymakers. Various forms of psychotherapy have shown very interesting results as adjunct treatments to the standard pharmacological approach in chronic and debilitating disorders. These interventions not only alleviate symptomatology and enhance quality of life for the patient: they also prove to be cost-effective in the mid- to long term.

The editors, both researchers at Boston University, are well aware of the fact that defining what empirically validated treatments are is a controversial issue per se. Thus, the selection of treatment protocols was made on the basis of the lists of “empirically validated treatments” and “probably efficacious treatments” made by Division 12 of the American Psychological Association. A variety of search engines was used to identify recent studies that could meet the criteria for one of the two aforementioned categories. Those treatments considered to be “probably efficacious” are mostly new interventions with good methodological foundations that have shown promising results.

Hofmann and Tompson have gathered twenty treatment protocols designed for disorders such as schizophrenia, bipolar and monopolar depression, suicidality, substance use and abuse and severe personality disorders.

These treatment protocols are based on a variety of theoretical approaches, including motivational interviewing, cognitive behavioural therapy, personal therapy, interpersonal therapy and short-term dynamic psychotherapy among others. The editors have been successful in gathering contributions from international experts in each field. The introductions to each section of the book offers information on the clinical relevance of the disorder and on the criteria for choosing each contribution.

The chapter on schizophrenia includes two papers with a cognitive behavioural approach: one by I. R. H. Falloon on family and educational interventions and one by N. Tarrier & G. Haddock on a case formulation approach to the disorder. S. Pratt & K. T. Mueser have contributed a paper on social skills training and G. Hogarty authored one on personal therapy for the stabilization of schizophrenia.

The chapter on mood disorders includes six articles, three of which refer to the application of cognitive-behavioural and interpersonal psychotherapies for monopolar and bipolar depression. These articles were authored by K. Hamilton & K. S. Dobson, M. Otto & N. Reilly-Harrington and by H. Swartz, J. C. Markowitz & E. Frank. There are also family and couple interventions for bipolar and monopolar depression respectively (by D. Miklowitz and by D. K. O’Leary) and a family intervention for adolescent suicide attempters (by Rotheram-Borus, A. M. Goldstein & A. S. Elkavich).

The chapter on substance use and abuse is, perhaps not surprisingly, the most diverse of all four. It includes five articles, all of them with a different theoretical perspective. The editors have chosen to emphasise the treatment of alcohol use and abuse, given its prevalence and clinical significance. The first one, by N. S. Handmaker & S.T. Walters, presents a motivational interviewing approach to problem drinking and drug use. The second, by T. A. O’Leary & P. M. Monti, presents a cognitive-behavioural protocol for alcohol addiction. The third article presents a twelve-step approach to alcohol problems by J. Nowinski. Finally, M. J. Rorbaugh & V. Shoham offer a couple intervention for alcohol abuse based on a systemic family-consultation model. S. T. Higgins, S. C. Sigmon and A. J. Budney contributed the last article of this section, dealing with cocaine dependence from an original approach: community reinforcement plus vouchers.

The fourth and last chapter of the book deals with severe personality disorders. This includes an article by K. Koerner & M. Linehan on dialectical behaviour therapy for borderline personality disorder. The cognitive-behavioural approach is represented by A. Freeman’s paper on the treatment of severe personality disorders. N. Kuhn & L. McCullough have contributed an article on short-term dynamic psychotherapy. Their intervention aims at resolving character pathology by treating affect phobias. Systemic and family interventions are represented by two articles: one on multiple family group treatments for borderline personality disorder (by T. Whitehurst, M. E. Ridolfi & J. Gunderson) and another one of multisystemic treatment of antisocial behaviour in adolescents (by E. Letourneau, P. B. Cunningham & S. W. Henggeler).

Most of the papers include some fundamental, updated information on the target disorder, sometimes with specific reference to different populations. They also include a basic presentation of the general theoretical and therapeutic framework, which is particularly useful given the diversity-and relative novelty- of many approaches. Treatment protocols are clear, and often a case example is included, which will be particularly useful for the clinician or policymaker who is not familiar with that psychological intervention.

The book is nicely printed and bound, with the usual austere presentation of other Guilford classics. The graphic design is certainly not memorable, but the paper is soft and opaque, making the book quite comfortable to read.

Treating Chronic and Severe Mental Disorders is, in my opinion, a valuable and useful book. Perhaps a second volume, covering other severe and chronic conditions, would be a good idea.

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© Eduardo Keegan.


Keegan, E. (2002). Review of Treating Chronic and Severe Mental Disorders: A Handbook of Empirically Supported Treatments edited by Stefan G. Hofmann and Martha C. Tompson. Human Nature Review. 2: 236-238.

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