The chapter presents the data about the behavioral methods that can be utilized for managing the symptoms associated with anxiety disorders, obsessive-compulsive disorder (OSD), and post-traumatic stress syndrome (PTSD) (Wright, Basco, & Thase, 2017). The authors address commonly used approaches, such as exposure, cognitive restructuring, and reciprocal inhibition. The major points Wright et al. (2017) make are that anxiety disorders, PTSD, and OSD are caused by unrealistic fears, psychological activation or excessive anxiety in response to these stimuli, and the avoidance of triggers.
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Thus, it is crucial to interrupt the pattern of avoidance through behavioral interventions. Behavioral interventions for anxiety disorders can involve a four-step process, during which an assessment of symptoms and triggers should be performed, the prioritization of therapy targets and the coaching of anxiety management skills should be done, and the exposure to stressful stimuli should be implemented (Wright et al., 2017). The presented interventions should be first practiced during therapy sessions and, later, in homework assignments.
The techniques demonstrated in the vignettes, case examples, and videos include decatastrophizing, thought stopping, breathing training, and exposure therapy, including imaginal exposure and in-vivo exposure. These techniques are some of the most significant approaches to the management of anxiety-related disorders. Decatastrophizing aims at minimizing individuals’ catastrophic predictions by evaluating the existing evidence about the likelihood of the event, creating an action plan, developing a management plan, and reinforcing the value of decatastrophizing (Wright et al., 2017). Thought stopping can help patients in replacing negative thinking with positive or adaptive thoughts.
Breathing training is one of the approaches that prevent irregular breathing and hyperventilation associated with panic disorder, helping patients to regulate their breathing patterns. Exposure therapy, during which individuals are exposed to anxiety-provoking stimuli, is vital for overcoming patients’ avoidance of the events that can trigger anxiety (Wright et al., 2017). Imaginal exposure helps patients to visualize frightening situations while in-vitro exposure implies the direct confrontation with the stimulus for therapeutic purposes.
It is possible to say that the chapter presents valuable information about treatment measures available for individuals living with anxiety disorders, obsessive-compulsive disorder (OSD), and post-traumatic stress syndrome (PTSD). The primary strength of the authors’ points is that they are supported by examples from medical professionals’ practice. Moreover, Wright et al. (2017) discuss the possible challenges associated with the approaches they suggest.
For instance, they report that exposure therapy may be difficult for some patients, such as those diagnosed with agoraphobia. Another strength that can be identified is that the authors’ methods of treatment can be utilized not only during therapy sessions but at home and in situations where patients encounter triggers. For instance, individuals can use breathing exercises at any time, which can help them to minimize the level of anxiety when they feel nervous, uncomfortable, or panicked.
The potential weakness of the authors’ points is that they do not note whether the presented interventions can help individuals with a high level of anxiety or at the acute stage of OCD or PTSD. The possible suggestions that can be made are that the authors should adjust the techniques they discuss to the needs of patients with severe symptoms, too. At the same time, it is crucial to note that the presented interventions can decrease the level of anxiety in all patients to some extent, which is also significant for individuals diagnosed with anxiety-related disorders.
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The chapter discusses the aspects of the decision making in therapy sessions. Persons (2008) addresses all steps of the process in detail, paying attention to the ones that guide conceptualization and intervention during the session. One of the major points the author makes is that it is vital to prepare for the meeting with the individual by reviewing the Problem List and the aspects of the case and perform the patient’s assessment, paying attention not only to possible treatment targets but also own emotional responses. Moreover, Persons (2008) reports that agenda items should focus on significant treatment targets, high-priority problems on the Problem List, or an emotionally activated concern the patient has. Notably, the author addresses the peculiarities of working with high-risk multiple-problem patients, individuals presenting intense emotions, and those wanting to work on a different problem every week.
The chapter does not feature vignettes and videos; the techniques and steps the author presents are preparing for the session, completing a brief assignment, developing an agenda for the meeting and selecting agenda items, obtaining patient-therapist agreement on agenda items, and formulating the problem addressed during the therapy. Each of these stages of the decision-making process during a therapy session is significant but may be performed out of the stated order. Moreover, the author presents the case study of a student showing the symptoms of anxiety and depression (Persons, 2008). Finally, the aspects of the use of the formulation to generate intervention ideas, the process of obtaining the patient’s permission to proceed, and the monitoring of the impact of interventions are also addressed in the chapter.
It is possible to say that the primary strength of the chapter is that the author discusses the formulation process as a significant part of the decision making in detail. Persons (2008) provides examples of how each of the steps can be performed and addresses the possible challenges a therapist may encounter. For instance, the chapter outlines the situations in which the therapist may encounter difficulties while developing treatment targets, such as the ones when the information an individual provides is different from the behavior they show. It is also notable that the author informs the audience about the three types of patients, working with which may be associated with difficulties for the medical professional.
For example, when an individual presents a new problem each week, the therapist should determine whether it is effective to work on different issues or it can be considered a therapy-interfering behavior. In light of the facts presented above, the chapter features a detailed and potentially reliable theory on the tasks associated with the decision-making process during therapy sessions.
The potential weakness of the author’s points is that Persons (2008) does not refer to alternative approaches and methods of decision making. The chapter does not include references to scholarly works and existing evidence, which means that the presented steps may be ineffective. Moreover, the basis for the author’s claims is unclear, as there are no links to studies in the field. One of the suggestions that can be made is that Persons (2008) may provide references to other works and improve the presented theory by adding the steps or the alternative methods of the decision-making process other authors offer.
Persons, J. B. (2008). The case formulation approach to cognitive-behavior therapy. New York, NY: Guilford.
Wright, J. H., Basco, M. R., & Thase, M. E. (2017) Learning cognitive-behavior therapy: An illustrated guide (2nd ed.). Arlington, VA: American Psychiatric Publishing.