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Book Review   |    
Frontiers of Cognitive Therapy
David A. Casey, M.D.
Psychiatric Services 1998; doi:
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edited by Paul M. Salkovskis, Ph.D.; New York City, Guilford Press, 1996, 554 pages, $45

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The recent history of cognitive therapy has been marked by efforts to broaden its applicability to an ever-greater number of clinical applications. This erudite text, edited by Dr. Paul Salkovskis of Oxford University, continues this effort by bringing together many of the foremost researchers and clinicians in the field to describe, in the editor's words, the “present status of cognitive theory and therapy”

The theoretical basis of cognitive therapy is expanded and enriched in the first chapter by the current ideas of the seminal thinker in the field, Dr. Aaron Beck. Beck presents the concept of “modes,”which he defines as “structural and operational units of personality that serve to adapt an individual to changing circumstances” Through the use of the concept of modes, he deepens our understanding of how a web of schemas interact in a given individual to lead to the symptoms of psychiatric disorders.

In general, the first half of the text deals with the theoretical underpinnings of cognitive therapy as well as attempts to integrate theory with clinical practice. Current knowledge of cognitive processes is linked to advances in the field of memory processing. The biology of suicide and of depressive illness is examined from a cognitive viewpoint.

The remainder of Frontiers of Cognitive Therapy deals with the application of cognitive advances to a variety of clinical problems, including personality disorders, depression, anxiety disorders, eating disorders, sexual dysfunction, and substance use disorders. A great array of approaches are examined, including the use of schemas as the focal point of therapy and the role of empathy in cognitive work. Modifications of the cognitive approach for short-term work with inpatients are also discussed. The longstanding critique of cognitive therapy as simply a list of techniques is put to rest here. The contributors emphasize individual case conceptualization and treatment planning and make linkages between clinical application, theory, and empirical research.

Dr. Salkovskis is to be commended for maintaining a unifying style throughout the work. Chapters are chock full of information and are extensively referenced, making the book a full-course meal of cognitive therapy to be savored, rather than an introductory appetizer. The level of material assumes basic familiarity with cognitive therapy, and the intended audience would appear to be clinicians and researchers with a serious interest in the field.

Although wide in scope, the work is not encyclopedic. For instance, as the editor notes, it does not include a review of the use of cognitive therapy with couples or with psychotic patients. However, this is a minor criticism. On the whole, the work achieves its goal of mapping the frontiers of cognitive therapy.

Dr. Casey is associate professor in the department of psychiatry and behavioral sciences at the University of Louisville School of Medicine and is affiliated with the Norton Psychiatric Clinic in Louisville, Kentucky.




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