Treatment of Stress Response Syndromes

Treatment of Stress Response Syndromes is a gem of a book. Although it is short, it includes both narrative and detailed tables and manages to quietly cram all you wanted to know but were afraid to ask about management into a concise readable format. The book's author, Mardi J. Horowitz, is eminently suited to discussing the topic of stress response syndromes and their treatment, having been involved in teaching and research on the topic for some 30 years. In fact, his first-edition book, Stress Response Syndromes, appeared in 1976. Horowitz is currently a professor of psychiatry at the University of California, San Francisco.

The book's structure belies the experienced clinician's systematic approach to this sometimes chaotic, overwhelming psychiatric disorder. The book has eight chapters on treatment that bear mentioning because they offer a studied, linear plan for treatment and management. The chapters cover orientation and treatment goals, evaluation, support, exploration of feelings, improving coping, working through, terminating treatment, and assessment of outcome.

Each chapter stands on its own and includes cogent case examples that amplify the text. In addition, each chapter has immediately useful tables and quick assessment tools that clinicians can incorporate into their practice with little stress. The writer's voice shines through the text. I offer one example of his readable, no nonsense style: "Restitution, as in good works to help others, is often a more adaptive way to expiate guilt. Another way of coping with unresolved topics is to use the conventional 'meat and potatoes' psychotherapy technique of helping the patient review cause-and-effect sequences so as to differentiate reality beliefs from fantasy beliefs."

Treatment of Stress Response Syndromes has a place on the bookshelf of any practicing psychiatrist or psychologist, whether community or hospital based. My only slight quibble is the absence of references to burnout or compassion fatigue among clinicians dealing with this specific population of individuals with posttraumatic stress disorder. Writers such as Charles Figley (1) and William Grosch and David Coleman (2) have addressed this subtle—but very real—issue.

Dr. O'Malley is a lecturer in the department of psychiatry and behavioral sciences of the University of Washington in Seattle.