Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual, 5th ed

edited by David H. Barlow, PhD. Guilford Press, New York, NY, 2014, 768 pages, $85.00 (trade cloth).

David Barlow has again compiled the collective wisdom of leading authorities on common mental health problems among adults in his fifth edition of the Clinical Handbook of Psychological Disorders. The book showcases the use of evidence-based psychotherapeutic psychosocial practices to assess and treat a range of psychological disorders involving anxiety, posttraumatic stress, depression, bipolar conditions, psychosis, alcohol and drug use, sleep disturbance, eating problems, and couple distress. Chapters are clearly organized, concisely written, and full of information about the conceptual and empirical bases of the evidence-based practices. Authors summarize main treatment effects, mechanisms of action, and treatment moderators (eg, client, therapist, social, and setting characteristics). The approaches covered are largely cognitive behavioral in orientation, although several chapters cover “third wave” treatments that incorporate mindfulness-based components with more traditional cognitive and behavioral interventions.

Barlow notes that one of the primary aims of the Clinical Handbook is to answer the most frequently asked question when learning a new evidence-based practice: “How do I do it?” In this regard, the Clinical Handbook succeeds in offering its readers procedures for assessment, case formulation, treatment planning, and intervention strategies and techniques. Clinical vignettes and transcripts populate the pages, which serve to exhibit the integration of theory, empiricism, and real-world practice. These clinical illustrations further demonstrate how proficient use of evidence-based practices involves the principled application of techniques individualized to meet patients’ needs instead of rigid adherence to manualized treatments. This realistic portrayal of the skill required to render treatments effectively is refreshing.

Barlow also promotes the idea of transdiagnostic protocols that can be used to treat a range of conditions, instead of relying on disorder-specific psychological treatments. Expecting therapists to learn a multitude of separate treatments for each disorder is impractical. Moreover, Barlow asserts that there are common etiologies of disorders that point to problems with emotional reactivity and inefficient or deficient regulatory control often manifested in attempts to avoid or alter emotional responding. These commonalities suggest that broad principles of change might occur across disorders and could result in greater capacity to treat patients who have multiple disorders using similar techniques (eg, creating and utilizing emotion-provoking exposures, guiding patients in how to examine their emotions without letting the emotions take over). I anticipate that the sixth edition of the Clinical Handbook will have many more demonstrations of such approaches that can be used across multiple disorders.

One shortcoming of the Clinical Handbook is the absence of discussion about empirically supported approaches for training people to proficiency in the evidence-based practices detailed in the book. Answering the question “How do I do it?” is not the same as answering the question “How do I learn it?” A concluding chapter detailing the merits of direct observation of practice, performance feedback, and repeated coaching would have been helpful in giving readers a realistic understanding of what it takes to master psychosocial treatments of psychological disorders and what their next steps might be after reading the book. In addition, supplemental web-based materials such as video demonstrations, treatment manuals, and downloadable assessment and self-monitoring tools could have made the Clinical Handbook an even more useful clinical guide and tool for students and therapists.

Nonetheless, the Clinical Handbook represents a substantial step forward in providing the field with a very well-written and easy to use textbook. As a reference resource, it will serve students and therapists like a favorite cookbook, with pages soiling over time as they return to seek clinical recipes that will help them better serve their patients.

Steve Martino, PhD

steve.martino@yale.edu

Author affiliations: Yale University School of Medicine, New Haven, Connecticut.

Potential conflicts of interest: None reported.

J Clin Psychiatry 2015;76(8):e1043

dx.doi.org/10.4088/JCP.15bk09891

© Copyright 2015 Physicians Postgraduate Press, Inc.