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High-Yield Cognitive-Behavior Therapy for Brief Sessions: An Illustrated Guide
Reviewed by Patricia A. Arean, PH.D.
Am J Psychiatry 2010;167:1413-1413. doi:10.1176/appi.ajp.2010.10081139
View Author and Article Information
San Francisco, Calif.

Book review accepted for publication August 2010

The author reports no financial relationships with commercial interests.

Accepted August , 2010.

Copyright © American Psychiatric Association

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Like the authors of this book, I am frequently asked by people I train in cognitive-behavioral therapy (CBT) how to use such strategies in brief sessions (≤30 minutes) or in combination with medication-management sessions. Given the growing commonality of brief treatment, there is a great need for a practically focused, how-to guide on effective use of CBT in situations when the conventional 50-minute session is not feasible. This book, and its accompanying DVD, successfully meets that need. Written by noted experts in the management of mental illness using combined approaches, this book is an easy to follow, highly readable, and well-organized training guide that any provider, regardless of their level of experience with CBT, will find useful in their clinical work.

The book begins with an overview of why mental health providers should learn these strategies (chapter 1) and provides the reader with guidance as to when brief treatment is warranted and when it is inappropriate to use brief treatment in lieu of conventional psychotherapy (chapter 2). Subsequent chapters focus on the strategies themselves and include the use of CBT for the management of affective, psychotic, and substance abuse disorders as well as the use of these strategies for insomnia, healthy lifestyle changes, coping with medical illnesses, and relapse prevention. Several common situations that providers are likely to encounter are also covered, with thorough descriptions of CBT for managing suicidal ideation, delusions and hallucinations, procrastination, and, in particular, adherence to medication.

The content of the book is supported with a number of excellent learning guides. The authors recommend that readers identify two to three cases in which they could practice using the strategies taught. Each chapter ends with exercises the reader should use in working with the practice cases, in order to reinforce the strategies taught. Ample written examples and case scenarios are given to illustrate how to use the strategies, how to prevent common issues in behavioral treatments (e.g., preventing the potential for patients to not follow through on assignments), and how to integrate the cases provided in the companion DVD to further support learning. The book also includes a copy of all the worksheets and tools discussed in each chapter, with a website reference for acquiring more copies, with the benefit being that the worksheets can be downloaded for free without purchasing the book. The book ends with an extensive resource guide for patients, families, and clinicians. This comprehensive referral list further supports the practicality of this text.

Of particular utility is the accompanying DVD, which provides examples of sessions covering many of the strategies taught in the text. These sessions are referred to and discussed in the chapters and therefore are very well integrated into the learning content. A problem with most DVD demonstrations of psychotherapy is the difficulty many viewers tend to have in separating out the therapist's therapeutic style from the strategies being taught. The authors overcome this barrier by providing examples of each author leading a brief session in their area of expertise, using their own unique interpersonal styles. Only a few minor omissions keep this excellent book from being an exceptional book. One of the biggest challenges many of my colleagues and I have faced in training providers in CBT is that most providers, regardless of their learning level, have not been trained in managing session time, using redirection and dealing with crises in a structure session. The lack of training in these fundamental brief treatment skills is, in my opinion, a considerable barrier in the adoption of brief treatment. Although the authors do discuss the use of agenda and limit setting in earlier chapters, these strategies, as well as how to keep patients focused on session content and coping with crises, deserve their own chapters and video clips, since these are not skills that are easy to learn from a book. Further, a majority of the audience who would read this book would be interested in seeing a brief session from beginning to end, where medication check-in and teaching CBT strategies would be done in one sitting. The DVD compilation would have benefited from the addition of an actual start-to-finish brief session. Because of its practical focus, the book is not heavy in theory or research data. However, the authors are generous with recommended readings for readers who wish to delve deeper into the theoretical principles of CBT and the research data that support its use.

Despite the minor limitations mentioned, this is an excellent reference guide for any provider wanting to learn how to use CBT strategies in brief sessions. It is readable and well supported with resources and references and an excellent demonstration DVD. I highly recommend this book to providers who work in brief sessions, primary care and psychiatry residents, and psychologists and social workers who provide services in unconventional settings.




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