Cognitive-Behavioral Therapy for Anxiety

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.

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.

Setting the Scene	p. 1
Treating Anxiety Disorders: The State of the Art	p. 3
Cognitive Therapy and Anxiety	p. 3
A Transdiagnostic View of Underlying Cognitive and Behavioral Processes	p. 5
Current Models and Protocols	p. 7
Embracing Complexity While Utilizing Specific Protocols	p. 21
Conclusion	p. 23
Deepening Understanding and Securing Engagement	p. 27
Assessment: Investigating Appraisals in Depth	p. 29
Standard Methods of Accessing Appraisals	p. 30
Targeting Higher Level Appraisals	p. 31
Input from Memory in the Anxiety Disorders	p. 34
How Should We Access "Hot Cognitions"?	p. 39
Conclusion	p. 46
Case Formulation: Making Sense of Complexity	p. 48
Principles Guiding Case Formulation	p. 49
Applying these Principles to Resolve Problems in Formulation	p. 49
Anxiety Disorders and Formulation Work: Mapping the Territory	p. 52
Judging the Quality of a Case Formulation	p. 54
Using Metaphors, Pictures, and Diagrams in Formulation Work	p. 56
Formulating Interactions between People	p. 60
Formulating Comorbidity with Different Kinds of Anxiety	p. 61
Conclusion	p. 70
Decentering from Thoughts: Achieving Objectivity	p. 71
The Metacognitive Perspective	p. 72
Aspects of Cognitive Therapy That Enhance Metacognitive Awareness	p. 72
Specific Methods for Enhancing Metacognitive Awareness	p. 75
Conclusion	p. 84
Facilitating Emotional Processing	p. 85
Bringing About Lasting Change at the Deepest Level	p. 87
Emotional Processing	p. 87
Spontaneous Cognitive Change as a Result of Simply Evoking Hot Material	p. 88
Using Traditional Cognitive Therapy Techniques to Prompt for Change, by Holding Old Material in Mind While Accumulating More Information	p. 90
Using the Properties of Imagery to Bring About Cognitive Change	p. 93
Unpacking and Transforming Metaphorical Images	p. 98
Conclusion	p. 104
The Role of Behavioral Experiments	p. 106
The Role of Behavior in Maintaining Anxiety	p. 108
Behavioral Interventions in Treatment	p. 109
Behavioral Experiments and Experiential Learning	p. 111
Creating Successful Behavioral Experiments: The Practicalities	p. 113
Alan's Behavioral Experiments: A Clinical Example	p. 116
Maximizing the Impact of Behavioral Experiments	p. 121
Therapist-Guided In-Session Experiments	p. 126
Conclusion	p. 127
Overcoming Three Major Obstacles to Progress	p. 131
Avoidance of Affect	p. 133
Transdiagnostic Features of Avoidance of Affect	p. 135
The Meaning of Affect	p. 136
Recognizing Avoidance of Affect	p. 137
Making Sense of Avoidance of Affect: Theories, Causes, and Consequences	p. 138
Strategies for Dealing with Avoidance of Affect	p. 142
Pitfalls and Difficulties	p. 150
Conclusion	p. 151
Low Self-Esteem	p. 153
A Cognitive Perspective	p. 154
The Relationship between Anxiety and Low Self-Esteem	p. 154
A Cognitive Model of Low Self-Esteem	p. 156
The Role of Rules for Living	p. 159
How the Bottom Line Is Triggered	p. 160
How Low Self-Esteem Is Maintained	p. 160
Treating Comorbid Anxiety and Depression: A Case Example	p. 161
Applying the Model	p. 164
Interventions Designed to Enhance Self-Esteem	p. 166
Questioning the Bottom Line: Undermining the Evidence	p. 168
Creating a New Bottom Line	p. 169
Conclusion	p. 173
Dealing with Uncertainty	p. 174
Making Sense of Anxiety and Uncertainty	p. 174
Anticipating and Avoiding Common Pitfalls	p. 176
Strategies Based on Standard Applications of Cognitive Therapy	p. 178
Acknowledging That Change Involves Taking Risks	p. 180
Strategies Derived from the Treatment of GAD	p. 181
Practical Tips	p. 184
Strategies for Helping People to Live with Uncertainty	p. 187
Conclusion	p. 190
Ending Treatment Productively	p. 193
Creating a Therapy "Blueprint"	p. 195
The Processes Involved in Ending Treatment	p. 196
A Personal Blueprint for Treating Anxiety Disorders	p. 207
References	p. 209
Index	p. 218
Table of Contents provided by Ingram. All Rights Reserved.

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Cognitive-Behavioral Therapy for Anxiety Disorders Mastering Clinical Challenges

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