Anxiety Disorders and Phobias A Cognitive Perspective

by Beck, Aaron; Emery, Gary; Greenberg, Ruth L

• ISBN13: 9780465005871
• ISBN10: 046500587X
• Edition: 15th
• Format: Paperback
• Copyright: 2005-06-29
• Publisher: BASIC BOOKS

Summary

At the forefront of the cognitive revolution, renowned psychiatrist Aaron T. Beck turned to information processing in order to understand the sources, consequences, and cures of anxiety disorders and phobias. In the first half of this classic text, Beck elaborates on the clinical picture of anxiety disorders and phobias and presents an explanatory model to account for the rich complexity of these phenomena. Cognitive psychologist Gary Emery then details the therapeutic principles, strategies, and tactics developed on the basis of the cognitive model of anxiety disorders and phobias. This fifteenth anniversary edition of the foundational work on cognitive therapy features a new introduction by Beck, in which he offers an up-to-date appraisal of the current state of cognitive therapy and its application to the treatment of phobias and anxiety.

Author Biography

Aaron T. Beck is university professor of psychiatry at the University of Pennsylvania School of Medicine, and Director of the Center for Cognitive Therapy in Philadelphia. Gary Emery is director of the Los Angeles Center for Cognitive Therapy and Assistant Clinical Professor in the Department of Psychiatry at UCLA. Ruth L. Greenberg is a psychologist in private practice, and trains psychotherapists at the Center for Cognitive Therapy. Aaron T. Beck is university professor of psychiatry at the University of Pennsylvania School of Medicine, and Director of the Center for Cognitive Therapy in Philadelphia. Gary Emery is director of the Los Angeles Center for Cognitive Therapy and Assistant Clinical Professor in the Department of Psychiatry at UCLA. Ruth L. Greenberg is a psychologist in private practice, and trains psychotherapists at the Center for Cognitive Therapy.

Table of Contents

Preface to the 2005 Edition	xv
Preface to the 1985 Edition	xxxi
PART I Theoretical and Clinical Aspects
BY AARON T. BECK
Chapter 1 Turning Anxiety on Its Head: An Overview	3	(16)
The Paradox of Anxiety
Changing Concepts of Anxiety
Distinguishing Anxiety, Fear, Phobias, and Panic
ANXIETY AND FEAR
PHOBIAS AND PANIC ATTACKS
"REALISTIC" AND "UNREALISTIC" FEARS
HOCH'S PARADOX
Future Danger and Present Danger The Function of Anxiety
ADAPTATIONAL ASPECTS
ANXIETY AS A STRATEGY IN RESPONSE TO THREAT
Survival Mechanisms
REFLEXES
DEFENSIVE PATTERNS
Chapter 2 Symptoms and Their Significance	19	(18)
Systems and Symptoms
SYMPTOMS AND FUNCTIONS
MAJOR REACTIONS: MOBILIZATION, INHIBITION, DEMOBILIZATION
FREE-FLOATING ANXIETY-FACT OR ARTIFACT?
NORMAL VERSUS PATHOLOGICAL ANXIETY
Thinking Disorder in Clinical Anxiety
ATTENTION, CONCENTRATION, AND VIGILANCE
"ALARM SYSTEM" AND "AUTOMATIC THOUGHTS"
LOSS OF OBJECTIVITY AND OF VOLUNTARY CONTROL
STIMULUS GENERALIZATION
CATASTROPHIZING
SELECTIVE ABSTRACTION AND LOSS OF PERSPECTIVE
DICHOTOMOUS THINKING
LACK OF HABITUATION
Classification of Anxiety Disorders
PANIC DISORDER
GENERALIZED ANXIETY DISORDER
POST-TRAUMATIC STRESS DISORDER
ATYPICAL ANXIETY DISORDER
PHOBIC DISORDERS
AGORAPHOBIA
SOCIAL PHOBIA
SIMPLE PHOBIA
Chapter 3 The Cognitive Model of Threat Reactions	37	(17)
The Role of Context
PRIMARY APPRAISAL
SECONDARY APPRAISAL
ESTIMATE OF DANGER
HOSTILE RESPONSE
The Nature of Cognitive Processing
THE RELATION OF BEHAVIORAL ACTIVATION AND INHIBITION TO MOTIVATION
DISTINGUISHING BETWEEN BEHAVIOR AND EMOTIONS
THE VICIOUS CYCLE
Primal Responses to Threat
THE ANERGIC AND THE ENERGIC SYSTEMS
CHANGES IN COGNITIVE CONTENT AND PHYSIOLOGICAL REACTIONS
THE RELATION OF ANXIETY TO OTHER DEFENSIVE RESPONSES
Chapter 4 Cognitive Structures and Anxiogenic Rules	54	(13)
Cognitive Schemas
THE FUNCTION OF COGNITIVE SET
THE CONTINUOUS CYCLE
The Modes
SYNDROMES AND MODES
ASSUMPTIONS, RULES, AND FORMULAS
RULES IN PROBLEMATIC SITUATIONS
RULES IN ANXIETY DISORDERS
Chapter 5 Vulnerability: The Core of Anxiety Disorders	67	(15)
The Concept of Vulnerability
THE ROLE OF SKILL DEFICITS
SELF-DOUBT
THE ROLE OF CONTEXT AND EXPERIENCE
INTERFERENCE WITH EFFECTIVE PERFORMANCE
CATASTROPHIC PREDICTIONS AND VICIOUS CYCLES
The "Function" of Dysfunctional Behaviors
PHYSICAL DANGER
PSYCHOSOCIAL DANGER
The Domains of Vulnerability
SECTORS OF THE DOMAIN
THREATS TO THE DOMAIN
THREATS TO SOCIALITY
THREATS TO INDIVIDUALITY
SPECIFIC FEARS
Chapter 6 Generalized Anxiety Disorder and Panic Disorder	82	(33)
Incidence
General View of the Etiology of Anxiety Disorders
BIOLOGICAL STUDIES
PRECIPITATING PSYCHOLOGICAL FACTORS
INTERACTION OF PRECIPITATING FACTORS WITH PREVIOUS PROBLEMS
DO COGNITIONS CAUSE ANXIETY DISORDERS?
Generalized Anxiety Disorder
SYMPTOMATOLOGY
TYPES OF GENERALIZED ANXIETY DISORDER
SPECIFIC FEARS
SELF-CONCEPT IN GENERALIZED ANXIETY DISORDER
SELF-CRITICISM IN ANXIETY AND DEPRESSION
THE DIFFERENCES BETWEEN ANXIETY AND DEPRESSION
Panic Disorder
DESCRIPTION
MEANING OF PANIC ATTACKS
FUNCTIONAL ANALYSIS OF PANIC ATTACKS
PRECIPITATION OF PANIC ATTACKS
Chapter 7 Simple Phobias	115	(18)
Definition of Phobia
DIFFERENTIATING PHOBIAS
FROM FEARS THE REFRACTORINESS OF PHOBIAS
CONTENT OF FEARS AND PHOBIAS
Classification
TRAUMATIC PHOBIAS
FIXATION PHOBIAS
SPECIFIC PHOBIAS
The Meanings of Phobias
MULTIPLE PHOBIAS: CONCEPTUAL CONTINUITY
Relation of Fears to Phobias
SELF-CONFIDENCE VERSUS VULNERABILITY
DUAL BELIEF SYSTEMS
VISUAL IMAGES
IDENTIFICATION WITH "VICTIM"
Evolution, Rules, and Phobias
Chapter 8 The Agoraphobic Syndrome	133	(13)
The Riddle of Agoraphobia
The Development of Agoraphobia
PREDISPOSITION AND PRECIPITATION
ONSET OF SYMPTOMATOLOGY
Panic
ATTRIBUTION OF CAUSALITY IN PANIC ATTACKS
COGNITIVE SET: VULNERABILITY
Dependency
A Synthesis
Chapter 9 The Evaluation Anxieties	146	(21)
The Essence of Evaluation Anxieties
BEFORE THE FALL
Common Features of Evaluative Threats
VULNERABILITY
STATUS AND RANKING ORDER
SELF-CONFIDENCE
RULES AND FORMULAS
AUTOMATIC PROTECTIVE REACTIONS
Social Phobias and Social Activities
Paradoxes of Social Anxiety
THE FEAR OF BEING EVALUATED
THE PRIMAL "DEFENSES"
Differentiating Social Phobia from Agoraphobia
SITUATIONS THAT PROVOKE THE PHOBIC SYMPTOMS
SOMATIC SYMPTOMS
The Phenomena of Social Anxiety
SHAME AND "SOCIAL IMAGE"
FEAR OF LOSS OF LOVE OR ABANDONMENT
PUBLIC-SPEAKING ANXIETY
TEST ANXIETY
A Synthesis
PART II Cognitive Therapy: Techniques and Applications
BY GARY EMERY
Chapter 10 Principles of Cognitive Therapy	167	(23)
Principle 1: Cognitive Therapy Is Based on the Cognitive Model of Emotional Disorders
DIDACTIC PRESENTATION
INTRODUCING COGNITIVE THERAPY
LEVELS OF FEAR
Principle 2: Cognitive Therapy Is Brief and Time-Limited
Principle 3: A Sound Therapeutic Relationship Is a Necessary Condition for Effective Cognitive Therapy
Principle 4: Therapy Is a Collaborative Effort Between Therapist and Patient
Principle 5: Cognitive Therapy Uses Primarily the Socratic Method
Principle 6: Cognitive Therapy Is Structured and Directive
Principle 7: Cognitive Therapy Is Problem-Oriented
CONCEPTUALIZATION
GENERAL STRATEGIES
Principle 8: Cognitive Therapy Is Based on an Educational Model
LEARNING TO LEARN
Principle 9: The Theory and Techniques of Cognitive Therapy Rely on the Inductive Method
Principle 10: Homework Is a Central Feature of Cognitive Therapy
Chapter 11 Strategies and Techniques for Cognitive Restructuring	190	(20)
Developing Self-Awareness
DIRECTING PATIENTS
Strategies and Techniques
COUNTING AUTOMATIC THOUGHTS
QUESTIONS
Three Basic Approaches
WHAT'S THE EVIDENCE?
WHAT'S ANOTHER WAY OF LOOKING AT IT?
SO WHAT IF IT HAPPENS?
Chapter 12 Modifying Imagery	210	(22)
Induced Images
DELINEATING MALADAPTIVE PATTERNS
PINPOINTING COGNITIVE DISTORTIONS
MODIFICATION OF INDUCED IMAGES
Techniques for Modifying Images
TURN-OFF TECHNIQUE
REPETITION
TIME PROJECTION
SYMBOLIC IMAGES
DECATASTROPHIZING THE IMAGE
IMAGES AND THOUGHTS
FACILITATING CHANGE IN INDUCED IMAGES
SUBSTITUTING POSITIVE IMAGERY
SUBSTITUTING CONTRASTING IMAGERY
EXAGGERATION
COPING MODELS
IMAGERY TO REDUCE THREAT
ESCAPING A WORSE ALTERNATIVE
MIXED STRATEGY
Future Therapy
Goal Rehearsal
Chapter 13 Modifying the Affective Component	232	(26)
Accepting the Feelings
REDUCING ANXIETY ABOUT ANXIETY
REDUCING SHAME ABOUT SHOWING ANXIETY
NORMALIZING ANXIETY
ACTIVE ACCEPTANCE
IDENTIFYING EMOTIONS
Action Strategies
ACTIVITY SCHEDULES
INCREASING TOLERANCE FOR ANXIETY
ALCOHOL, STIMULANTS, DIET, STRESS
MALADAPTIVE COPING BEHAVIOR
Self-Observation
POSITIVE SELF-INSTRUCTION
GRAPHS AND DIARIES
CONCENTRATION (OR DISTRACTION) EXERCISES
RELAXATION METHODS
Emotional Review
IMAGERY METHODS
METAPHORS
REPEATED REVIEW OUTSIDE THE OFFICE
Owning One's Emotions
SEQUENTIAL REASONING
CORRELATIONAL REASONING
ANALOGICAL REASONING
EMOTIONAL REASONING
THE PAYOFF
Chapter 14 Modifying the Behavioral Component	258	(30)
Identifying Protective Mechanisms
Motivation
EXPLAINING THE THERAPEUTIC APPROACH TO THE PATIENT
BLOCKS TO LEARNING
EDUCATIONAL DEVICES
FUTILITY OF SELF-PROTECTION
EXPERIMENTS
GRADED STEPS OR A GRADUAL APPROXIMATION
HIERARCHY
Aids to Exposure
INITIATION TECHNIQUE
SELF-INSTRUCTION
BEHAVIORAL REHEARSAL
THE USE OF SIGNIFICANT OTHERS
Technical Aids
COGNITIVE AVOIDANCE
The Critical-Decision Technique
SURPRISE
CHOICE
TASK ORIENTATION
BEHAVIORAL THOUGHT
The "As If" Technique
Shame and Other Feared Experiences
Developing Self-Confidence
AGREEING
DISAGREEING
DOING THE UNEXPECTED
MAKING A MISTAKE PART OF THE SHOW
Chapter 15 Restructuring a Patient's Assumptions and Major Issues	288	(25)
Identifying Assumptions Major Issues
IDENTIFYING MAJOR ISSUES
POSITIVE AND NEGATIVE REINFORCERS
PSYCHOLOGICAL DOUBLE
DEVELOPMENT OF MAJOR CONCERNS
Acceptance
Competence
Control
Motivation and Major Concerns
Postscript	313	(2)
Appendix I	315	(8)
Appendix II	323	(2)
References	325	(8)
Index	333