How to use this book

The Oxford Guide is designed for readers who are learning cognitive therapy and for those who have pre-existing skills. It assumes a basic knowledge of cognitive therapy and a capacity to undertake assessment, cognitive formulation, and basic therapeutic procedures.

A careful cognitive formulation is a prerequisite for designing and implementing effective behavioural experiments. The cognitions to be tested and, importantly, the context in which they are tested, will vary from case to case. Hence, experiments need to be individually designed and tailored to the particular requirements of the patient. The Oxford Guide provides plenty of examples of possible behavioural experiments, including some which are prototypical for particular problems. They are a stimulus for readers’ own creativity to adapt the experiments to the needs of their patients.

There is a sense in which the Oxford Guide has been designed as a ‘cook- book’—but not one with recipes to be slavishly followed irrespective of the context; rather, its purpose is to help readers understand the principles involved, so that an endless variety of new ‘dishes’ can be created.

Chapters 1 and 2 provide an introduction to behavioural experiments and a context for the remainder of the book. Chapter 1 discusses the conceptual basis for behavioural experiments: their role in cognitive therapy, their historical derivation, their clinical value, and theoretical explanations, which may account for their apparent impact. Chapter 2 provides a comprehensive practical guide to the design and implementation of behavioural experiments; it should be read prior to the remaining chapters to provide full understanding.

The remaining chapters of the book focus on particular problem areas. These include problems which have been the traditional focus of cognitive therapy (e.g. depression and anxiety disorders), as well as those which have only more recently become a subject of study (bipolar disorder, psychotic symptoms), and some which are still in their relative infancy (physical health problems, brain injury). Also included are several chapters on transdiagnostic problems (avoidance of affect, low self-esteem, interpersonal issues, selfinjurious behaviour). All these can be read as stand-alone chapters, but since problems are often interlinked, and useful behavioural experiments may be found in other chapters, a section at the end of each chapter directs the reader to other relevant chapters.

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To assist the reader, each chapter has the same basic structure:

1A basic description of the problem

2The application of the cognitive model(s) to the particular problem

3Key cognitions or cognitive constructs

4Behavioural experiments to test the key cognitions

5Distinctive difficulties in carrying out behavioural experiments with this population

6Other relevant chapters

7Further reading

Readers should note that the book is not intended to provide a comprehensive account of the cognitive models for each disorder; the references and further reading lists at the end of each chapter are for this purpose.

The behavioural experiments themselves are also presented in a standardized format for ease of understanding. Chapter 2 provides an explanation for the categories used. Experiments are set up to test a target cognition or an alternative perspective; a prediction is made, the experiment is carried out, the results are noted, and through a process of reflection, implications for the target belief are evaluated.

Even the best laid plans cannot cover every possibility. Unpredictable events intrude, and experiments do not always turn out the way those who devise them might imagine. Sometimes fortune shines, and there are unexpectedly serendipitous outcomes—and sometimes apparent disaster strikes. Flexibility and a wry sense of humour may be called for. Reflecting these facts, we have gathered together a collection of true—sometimes bizarre—stories of behavioural experiments, and inserted them between chapters under the collective title of

Tales from the Front Line. These tales are not intended to be taken entirely seriously, and do not always provide a particular therapeutic moral. The message, if any, is simply to be prepared to think on your feet—and if you and the patient can enjoy the humorous aspects of therapy, so much the better!

A note on terminology: we have used the terms ‘patients’ or ‘people’ rather than ‘clients’ throughout the book, and have used the latest version of DSM (DSM-IV- TR, APA 2000) to provide a basic description of many of the problems. There was considerable variation amongst the authors in degree of allegiance to these terms/concepts. The editors decided that, on balance, it was better to retain a standard nomenclature (patients) and to use DSM-IV-TR to provide a descriptive base. However, the shortcomings of both are acknowledged.

When we have referred to patients or therapists in the singular, our rule of thumb has been to alternate between ‘he’ and ‘she’. Although the behavioural experiment examples are based on real cases, identifying features, often including gender, have been changed to minimize any chance of recognition.

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Some readers may come to the Oxford Guide with little or no knowledge of cognitive therapy. If this is the case, we advise that they study one or more of the basic texts below and/or to attend some introductory workshops in cognitive therapy, prior to starting this book.