The Complete CBT Guide for Anxiety

482 Pages·2013·10.75 MB·English

by  Brosan

After more than three decades of research into cognitive behavioural therapy for anxiety disorders, there are
now scientifically-based protocols for treating them. This book pulls them together in a way that is
accessible to therapists, sufferers and their families. As many people have more than one type of anxiety
problem, the book first describes the principles of cognitive behavioural therapy that cut across specific
forms of anxiety. It also contains a comprehensive set of chapters on the treatment of the full range of
anxiety disorders from international experts. It will be an invaluable resource to those concerned with the
treatment of people suffering from anxiety, as well as to those with anxiety who want to learn how they can
help themselves.
Lord Richard Layard
Programme Director at the Centre for Economic Performance at the London School of Economics

Everyone suffering from various forms of anxiety and fear as well as therapists trying to help people with
these difficulties will find this beautifully written manual extraordinarily valuable. For in it one will see
what is common about different types of anxiety disorders from social anxiety to obsessions, as well as the
essential differences, along with all of the important strategies for overcoming and mastering these thorny
problems. This manual should be prescribed to everyone attempting to grapple with anxiety and its
disorders.
David H. Barlow Ph.D, ABPP
Professor of Psychology and Psychiatry
Founder and Director Emeritus, Center for Anxiety and Related Disorders at Boston University
Nicole M. Alberts is a PhD student in clinical psychology at the University of Regina, Canada. Her
research and clinical interests include health anxiety as well as the assessment and treatment of mood and
anxiety disorders and their associations with health conditions.
Lee Brosan is a Consultant Clinical Psychologist in the Cambridgeshire and Peterborough Foundation
Trust and Trust Lead for the Development of Psychological Therapies. She is a Clinical Associate at the
MRC Cognitive and Brain Science Unit in Cambridge, and a founder member of the Cambridge Clinical
Research Centre for Affective Disorders (C2:AD). She has been qualified as a cognitive therapist for nearly
twenty years.
Gillian Butler is a Consultant Clinical Psychologist working with Oxford Cognitive Therapy Centre and
Oxford Health NHS Foundation Trust. Through ten years of clinical research with the University of Oxford
in the 1980s she helped to develop CBT for social phobia, and to evaluate its effectiveness. One of her
interests is in writing about current practices in CBT, so as to help people resolve problems such as the
social anxiety that can otherwise interfere with their lives.
David M. Clark is Professor of Experimental Psychology and Fellow of Magdalen College, University of
Oxford. He is a Fellow of the British Academy (London), a Fellow of the Academy of Medical Sciences
(London), an Honorary Fellow of the British Psychological Society, and Distinguished Founding Fellow of
the Academy of Cognitive Therapy (USA). Among other awards and honours, he has received the
following during his career: the May Davidson Award (British Psychological Society); the American
Psychological Association Distinguished Contribution to Applications of Psychology Award; the Academy
of Cognitive Therapy’s Research Award; an Honorary Doctorate of Science from the London School of
Economics (LSE), and has been voted a World Leader in Anxiety Disorders Research by members of the
Anxiety Disorders of America Association (1998).
Peter Cooper is Co-director of the Winnicott Research Unit and Research Director of the Berkshire Child
Anxiety Clinic. He holds a research chair in the School of Psychology and Clinical Language Sciences at
the University of Reading. His principal current research interests concern elucidating the impact of early
environmental factors on child socio-emotional development and evaluating intervention programmes to
mitigate this impact; and developing and evaluating interventions to (i) improve clinical outcomes in
anxious children and children with certain congenital abnormalities, and (ii) facilitate optimal child socio-
emotional and cognitive development in the developing world.
Anke Ehlers is a Wellcome Trust Principal Research Fellow and Professor of Experimental
Psychopathology at the Department of Experimental Psychology, University of Oxford. She is Co-director
of the Centre for Anxiety Disorders and Trauma, Maudsley Hospital, London, and the Oxford Centre for
Anxiety Disorders and Trauma. She is a Fellow of the British Academy and the German Academy of
Sciences Leopoldina. Her main research interests are the etiology and treatment of anxiety disorders, in
particular post-traumatic stress disorder (PTSD), panic disorder, and social phobia. She co-chaired the
NICE Post-traumatic Stress Disorder Guideline (2005) Development Group.
Mark Freeston is Head of Research and Development at the Newcastle Cognitive and Behavioural
Therapies Centre and Professor of Clinical Psychology at Newcastle University. He divides his time
between NHS duties, where he directed the Newcastle Diploma in Cognitive Therapy for ten years, and the
University of Newcastle, where he teaches research methods. He has published extensively on intrusive
thoughts, OCD, worry and their treatment, leads an active research programme, and provides workshops on
their treatment in the UK and elsewhere.
Nick Grey is a Consultant Clinical Psychologist and Joint Clinical Director of the Centre for Anxiety
Disorders and Trauma (CADAT), South London & Maudsley NHS Foundation Trust. He helps develop and
disseminate cognitive therapy treatments for people with anxiety disorders and post-traumatic stress
disorder (PTSD).
Heather Hadjistavropoulos is a Professor of Psychology and Director of Clinical Training at the
University of Regina, Canada. She founded the Psychology Training Clinic and the Online Therapy Unit at
the University of Regina, and offers training to students and community providers in the assessment and
treatment of anxiety and mood disorders. Her research aims to improve: anxiety and depression in medical
and nonmedical populations; quality of health care; and training in clinical psychology.
Shannon L. Jones is in the final year of her training as a PhD student in clinical psychology at the
University of Regina, Canada. Her research interests focus primarily on anxiety disorders and anxiety-
related conditions, health psychology, and online cognitive-behaviour therapy. Clinically, Shannon’s
interests are in the assessment and treatment of adults with anxiety and mood disorders and in clinical
health psychology settings, including psychosocial oncology.
Freda McManus is a Consultant Clinical Psychologist. She is currently Acting Director of the Oxford
Cognitive Therapy Centre, and a Clinical Research Fellow in the University of Oxford’s Department of
Psychiatry. She has worked clinically for twenty years and has a range of experience in developing and
evaluating CBT interventions for anxiety disorders as part of research teams at the University of Oxford and
at the Institute of Psychiatry, King’s College London. She has published widely in both clinical and
academic texts, in the areas of CBT for anxiety disorders, and on training healthcare professionals to carry
out CBT interventions.
Kevin Meares is a Consultant Clinical Psychologist and an accredited Cognitive Behavioural Therapist. He
works for the Northumberland, Tyne and Wear NHS Foundation Trust at the North East Traumatic Stress
Centre. He has been a therapist for more than fifteen years. He is an experienced supervisor and trainer,
regularly leading CBT workshops on GAD and PTSD. In 2008 he co-authored the self-help book
Overcoming Worry with Professor Mark Freeston.
Lars-Göran Öst is Professor of Clinical Psychology at Stockholm University, Sweden, and also has a part-
time position as Professor at the University of Bergen, Norway. He has published more than 200 articles,
book chapters and books, and runs his own private practice. His main research interests include: phobias;
panic disorder; generalized anxiety disorder; obsessive-compulsive disorder; anxiety disorder in children;
therapy outcome studies; therapist behaviours; therapist–patient relationship; working alliance; etiology of
anxiety disorders; field efficacy; implementation, and schizophrenia.
Adam S. Radomsky is an Associate Professor in the Psychology Department at Concordia University in
Montreal, Canada, and was the Founding President of the Canadian Association of Cognitive and
Behavioural Therapies. His research on the roles of cognition in understanding and treating OCD and other
anxiety disorders is funded by the Canadian Institutes of Health Research and has garnered several national
and international awards. Dr Radomsky maintains a small private practice in Montreal, and is actively
engaged in the training of new CBT therapists.
Roz Shafran is Professor of Clinical Psychology at the University of Reading and founder of the Charlie
Waller Institute of Evidence-based Psychological Treatment. She is a former Wellcome Trust Career
Development Fellow at the University of Oxford. Her clinical research interests include cognitive
behavioural theories and treatments for eating disorders, obsessive compulsive disorder and perfectionism
across the age range. More recently, her work has addressed the dissemination and implementation of
evidence-based psychological therapies. She has numerous research papers, book chapters and conference
presentations in these areas. She is the scientific co-chair of the British Association of Behavioural and
Cognitive Psychotherapies and associate editor of Behaviour Research and Therapy. She recently received
an award for Distinguished Contributions to Professional Psychology from the British Psychological
Society and the Marsh Award for Mental Health work.
Jennifer Wild is a Consultant Clinical Psychologist and Senior Research Fellow in Clinical Psychology at
the University of Oxford. She is an international expert in the treatment of post-traumatic stress and anxiety
disorders. She treats victims of major traumatic events, such as the 2011 Oslo shootings, the 2004 Indian
Ocean tsunami in Thailand and the 2012 Costa Concordia disaster. Jennifer is currently leading a
programme of research with the London Ambulance Service, the world’s largest emergency service, to
develop a programme to reduce psychological stress after trauma. She frequently appears in the news and
writes articles for TV, radio and the press about psychological issues and PTSD.
The Complete
CBT Guide for
Anxiety
Roz Shafran, Lee Brosan and
Peter Cooper
London
Constable & Robinson Ltd 55–56 Russell Square
London WC1B 4HP
www.constablerobinson.com
First published in the UK by Robinson,
an imprint of Constable & Robinson Ltd, 2013
Part One & Part Three copyright © Roz Shafran, Lee Brosan and Peter Cooper, 2013 Specific Phobias
copyright © Roz Shafran and Lars-Göran Öst, 2013 Panic Disorder copyright © Nick Grey and David M
Clark, 2013 Generalized Anxiety Disorder and Worry copyright © Kevin Meares and Mark Freeston, 2013
Social Phobia copyright © Gillian Butler and Freda McManus, 2013 Health Anxiety copyright © Nicole M.
Alberts, Shannon L. Jones and Heather D. Hadjistavropoulos, 2013 OCD copyright © Roz Shafran and
Adam S. Radomsky, 2013 PTSD copyright © Jennifer Wild and Anke Ehlers, 2013
The right of Roz Shafran, Lee Brosan and Peter Cooper to be identified as the authors of this work has been
asserted by them in accordance with the Copyright, Designs and Patents Act 1988
All rights reserved. This book is sold subject to the condition that it shall not, by way of trade or otherwise,
be lent, re-sold, hired out or otherwise circulated in any form of binding or cover other than that in which it
is published and without a similar condition including this condition being imposed on the subsequent
purchaser.
A copy of the British Library Cataloguing in
Publication data is available from the British Library Important Note
This book is not intended as a substitute for medical advice or treatment. Any person with a condition
requiring medical attention should consult a qualified medical practitioner or suitable therapist.
Although we have tried to trace and contact copyright holders before publication, this has not been possible
in all cases. If notified, the publisher will be pleased to correct any errors or omissions at the earliest
opportunity.
ISBN 978-1-84901-896-8 (paperback)
ISBN 978-1-78033-132-4 (ebook)
Printed and bound in the UK
1 3 5 7 9 10 8 6 4 2
Dedication

We dedicate this book to our families for all their support, particularly to
David, Matthew, Anna and Rachel Gittleson, Tina and Michael Shafran,
and Angus Mackintosh.
Contents
Acknowledgements
INTRODUCTION
Why we wrote this book
Is this book for you?
The aim of this book
How to use this book
Anxiety and medication
PART 1:
Common features of cognitive behavioural therapy
for different anxiety problems
Introduction to Part 1: What is anxiety?
1 How CBT works
2 The importance of your interpretations
3 Vicious versus virtuous cycles
4 Why your anxiety persists
5 Making changes
PART 2:
CBT for specific anxiety disorders
6 Specific phobias
7 Panic disorder
8 Generalized anxiety disorder and worry
9 Social phobia
10 Health anxiety
11 Obsessive compulsive disorder
12 Post-traumatic stress disorder
PART 3:
Tackling other problems and maintaining progress
13 The importance of mood and relationships in anxiety
14 Relapse prevention: your ‘blueprint’ for survival
Appendix 1 References
Appendix 2 Further Reading
Appendix 3 Other Useful Resources
Appendix 4 Blank Worksheets
Index