- Email: [email protected]
Problem behaviour in people with severe learning disabilities
588
8ooK REVIEWS
clinical experience or upon research. Whilst views based on the former are particularly welcome from such an experienced clinician it is important to be clear, particularly when different views are held and/or interpretations are made. Despite these reservations, the book does contain clear, up to date information. In fact the book’s strength rests on the way in which the author has presented medical information in a way which makes it accessible to the general reader. This is particularly so in the sections on abortion, infertility and treatment thereof and sexually transmitted diseases. The author has attempted to provide a comprehensive text in a difficult and controversial area. Although satisfactory in some areas, the book cannot hope to provide a comprehensive overview of sexuality and should be read in conjunction with other books. SHARONDAWE
DAVID BARLOW and JEROMECERNY: Psychological
Treatmenr of Panic. Guilford Press, New York (1988). 227 pages.
Hardback $30.00; Paperback $14.95. “In the context of wide publicity over drug treatments for panic, few practitioners are even aware that successful psychosocial treatments exist”, (p. vii). The unchallenged supremacy of the biological theory of panic is now over, and in that light Barlow and Cerny set themselves two objectives. They wish to inform and instruct practitioners, and bring to the attention of the profession the important new developments in understanding panic disorder. The evidence to support the clinical effectiveness of the new psychosocial methods is far from complete but the authors are optimistic, and feel that the new psychological treatments for panic “may turn out to be one of the more important developments in the history of psychotherapy” (p. 49). Certainly the early signs are extremely encouraging, and this book, a mixture of competent instruction and enthusiasm, will promote further progress. It is the first in a new series of treatment manuals to be published by Guilford Press under the general editorship of Dr Barlow. The first three chapters deal with the nature and consequences of panic, and how it can be diagnosed and assessed. Barlow and Cerny provide a succinct and balanced introduction to the subject that can stand on its own. The next five chapters deal with general matters of therapy, followed by specific instructions on the conduct of the relaxation treatment component of the treatment, then the cognitive component, and finally the exposure component. This three-component treatment program draws on earlier work, but the particular combination was developed at the renowned Albany Clinic, where Barlow and his colleagues have carried out volumes of important research on this and related topics during the past 10 yrs. The elements of the program that are specific to the treatment of panic deserve greater attention than they receive. The chapters on the nature and consequences of panic are masterly, but the section on assessment has some weaknesses. More information about the new standardized interview method would have been helpful, and the problems of cognitive monitoring and the recording of panics and anxiety on the weekly forms are not dealt with fully. A section on trouble-shooting would have been welcome. This well-written book by a leading authority is likely to be successful. S.
RACHMAS
J. G. BEAUMONT:Understanding Neuropsychology. Blackwell, Oxford (1988). x + 150 pages. Hardback f25.00; Paperback f6.95. This book is one of a series of introductory volumes appropriate for students studying ‘A’ level psychology. It would also be useful as a basic introduction to those interested in neuropsychology from a lay point of view, as an introduction for paramedical professional groups and those on other courses in which psychology is a component. Understanding Neuropsychology might also be useful as initial reading for undergraduate psychology students, especially those with a limited background in science subjects. The text is divided into four chapters. These are a general introduction to the nervous system, sensation and perception, the cerebral cortex, and the subcortex. At the end of each chapter, a number of discussion points and practical exercises are listed. Also included separately at the end of each chapter are critical reviews of two important publications relevant to the content of the chapter. Experimental design, methods, analysis and interpretation of results are given in some detail. The book fulfills its purpose as a very basic, brief introductiory text, which is likely to stimulate interest in the novice to this field. As such it is not an applied book, although it covers the study of normal and brain-damaged subjects. It is less likely to be of value to clinical psychologists than Professor Beaumont’s earlier book, Introducrion IO Seuropsychology. T.
MCMILLAS
E. ZARKOWSKA and J. CLEMENTS:Problem Behaciour in People with Severe Learning Disabilities. Croom Helm, London (1988). xi + 180 pages. f10.95. This is a very readable book, based on real-life situations, reflecting the authors’ extensive ‘hands on’ experience with both children and adults. The authors take an overall view in accepting the contributions of chemical intervention, socially orientated and behavioural approaches. They point out that adherence to just one strategy will result in limited effectiveness, and recommend a ‘multi-component’ approach. They recognise that this approach requires considerable time
BOOKREVIEWS
589
and manpower, plus careful attention to or8anisational issues; these requirements are all too often hard to come by, but at the least this book provides clear goals to aim at. and the simple graphics throughout the book clearly summarise the recommended strategies. It is regrettable that by espousing the acronym S.T.A.R. (Settings, Triggers, Actions and Results). the authors appear unaware of Chris Williams’s S.T.A.R. (Social Training Achievement Record), thus the two might collide with resulting confusion. The chapters on teaching skills and enhancing existing skills are very comprehensive, the programmes being set out in a series of logical steps. As the theme of the book is the long term management of unacceptable behaviours, emphasis is placed on the necessity to compete these out by more acceptable alternative skills. A later chapter discusses ways to encourage self-management. a very desirable but difficult goal to attain. As well as much practical advice, the authors helpfully address organisational and ethical issues. Their programmes require a very active commitment by the service agency and the carers, who must create an effective ‘multi~om~nent’ team who can give each other the support and encouragement essential for the long term (but rewarding) work which such programmes demand. In summary, this book could join the all too short list which is readable, reliable and realistic. It contains a great deal of useful information, conveyed in a sensible and interesting way. By no means the least sensible aspect is that it eschews the esoteric but often plain confusing term ‘challenging’, and more comprehensibly describes certain hhaviours as problems. Problems are made to be solved: this book provides a great many solutions, at a very reasonable price. E. C.
WRIGHT
and S. C. BEIDEL: TrearingObsessive-Compulsil~e Disorder. Pergamon Press, New York (1988). ix + 128 pages. Paperback f9.25; Hardback f 16.50.
S. M. TURNER
This book aims to provide clinicians with an up to date account of effective treatment strategies for obsessive-compulsive disorder, to help those with an appropriate background to implement treatment, and to provide students and trainees with an introduction to the area. Remarkably, within a fairly compact volume, all three aims are achieved very well indeed. Discussions of the phenomenology, differential diagnosis and a review of the clinical literature are lucid, objective and comprehensive. The assessment and treatment sections are sufficiently detailed and practical to act as guides to trainee therapists although the treatment approach used by the authors is an unusually rapid, hospital-based one with a greater emphasis on staff involvement in response prevention than is usual these days. However, alternative styles of delivery of behaviour therapy are discussed. Finally, this is one of those rare books which can be recommended to trainees without the need for a series of caveats and qualifiers. BOB MCDONALD
BRIDGE, A. F. MIRSKY and F. K. GWDWIN (Eds): Ps.~chological, Neuropsycbiat~~c and Substance Abuse Aspects of AIDS. Raven Press, New York (1988). xxv + 261 pages. S37.50.
T. P.
This book is aimed at researchers studying the immune, virologic and CNS mediated mechanisms of HIV. What it sets out to do is present a series ofchapters, collectively arguing that the success of developing treatment and preventive measures must include the fields of neuroscience, behaviour and substance abuse. To this end the book, comprising a total of twenty-four chapters, seems to fall into four sections. The first looks at the immune system and its relationship with the CNS, describing its molecular components and neuroendocrine properties. Whilst clearly written, a basic understanding of neuroanatomy is necessary. The second section examines the neuropsychiatric aspects of HIV disease and opens with a chapter presenting various models describing the psychiatric sequelae of AIDS. There is an interesting chapter by Cohen examining the biological mechanisms associated with psychological and emotional states-in particular, despair, depression and hopelessness. These are discussed in relation to an immunological response. By way of illustration, Cohen makes an interesting analogy between the bio-psychosocial interactions seen in AIDS to those observed in Vodoo. The third section addresses co-factors in host susceptibility to HIV and disease outcome, including cocaine, opiates, alcohol and gender differences. Discussion regarding the possible mechanisms through which such co-factors operate is particularly good in this section. The finai section reflects and brings together the preceding chapters by presenting a bio-psychosocial approach to AIDS which is multi-factorial. This model acknowledges the interaction of genetic, behavioural, situational and cultural factors, and highlights the considerable methodological problems encountered in this area of research. In an excellent opening chapter to this section, Temoshock presents preliminary outcome data from a longitudinal psychological study of men with AIDS and ARC and discusses the relationship of psychological variables to disease outcome. With the exception of the last, other chapters in the final section examine behavioural and psychosocial modulators of immunocompetence and are of a consistently high standard. The final chapter, which discusses legal and ethical issues surrounding HIV. does not tit easily with either the other chapters or the scope of the book. In conclusion, this book makes a valuable contribution to the literature. MARY BURGESS
8ooK REVIEWS
clinical experience or upon research. Whilst views based on the former are particularly welcome from such an experienced clinician it is important to be clear, particularly when different views are held and/or interpretations are made. Despite these reservations, the book does contain clear, up to date information. In fact the book’s strength rests on the way in which the author has presented medical information in a way which makes it accessible to the general reader. This is particularly so in the sections on abortion, infertility and treatment thereof and sexually transmitted diseases. The author has attempted to provide a comprehensive text in a difficult and controversial area. Although satisfactory in some areas, the book cannot hope to provide a comprehensive overview of sexuality and should be read in conjunction with other books. SHARONDAWE
DAVID BARLOW and JEROMECERNY: Psychological
Treatmenr of Panic. Guilford Press, New York (1988). 227 pages.
Hardback $30.00; Paperback $14.95. “In the context of wide publicity over drug treatments for panic, few practitioners are even aware that successful psychosocial treatments exist”, (p. vii). The unchallenged supremacy of the biological theory of panic is now over, and in that light Barlow and Cerny set themselves two objectives. They wish to inform and instruct practitioners, and bring to the attention of the profession the important new developments in understanding panic disorder. The evidence to support the clinical effectiveness of the new psychosocial methods is far from complete but the authors are optimistic, and feel that the new psychological treatments for panic “may turn out to be one of the more important developments in the history of psychotherapy” (p. 49). Certainly the early signs are extremely encouraging, and this book, a mixture of competent instruction and enthusiasm, will promote further progress. It is the first in a new series of treatment manuals to be published by Guilford Press under the general editorship of Dr Barlow. The first three chapters deal with the nature and consequences of panic, and how it can be diagnosed and assessed. Barlow and Cerny provide a succinct and balanced introduction to the subject that can stand on its own. The next five chapters deal with general matters of therapy, followed by specific instructions on the conduct of the relaxation treatment component of the treatment, then the cognitive component, and finally the exposure component. This three-component treatment program draws on earlier work, but the particular combination was developed at the renowned Albany Clinic, where Barlow and his colleagues have carried out volumes of important research on this and related topics during the past 10 yrs. The elements of the program that are specific to the treatment of panic deserve greater attention than they receive. The chapters on the nature and consequences of panic are masterly, but the section on assessment has some weaknesses. More information about the new standardized interview method would have been helpful, and the problems of cognitive monitoring and the recording of panics and anxiety on the weekly forms are not dealt with fully. A section on trouble-shooting would have been welcome. This well-written book by a leading authority is likely to be successful. S.
RACHMAS
J. G. BEAUMONT:Understanding Neuropsychology. Blackwell, Oxford (1988). x + 150 pages. Hardback f25.00; Paperback f6.95. This book is one of a series of introductory volumes appropriate for students studying ‘A’ level psychology. It would also be useful as a basic introduction to those interested in neuropsychology from a lay point of view, as an introduction for paramedical professional groups and those on other courses in which psychology is a component. Understanding Neuropsychology might also be useful as initial reading for undergraduate psychology students, especially those with a limited background in science subjects. The text is divided into four chapters. These are a general introduction to the nervous system, sensation and perception, the cerebral cortex, and the subcortex. At the end of each chapter, a number of discussion points and practical exercises are listed. Also included separately at the end of each chapter are critical reviews of two important publications relevant to the content of the chapter. Experimental design, methods, analysis and interpretation of results are given in some detail. The book fulfills its purpose as a very basic, brief introductiory text, which is likely to stimulate interest in the novice to this field. As such it is not an applied book, although it covers the study of normal and brain-damaged subjects. It is less likely to be of value to clinical psychologists than Professor Beaumont’s earlier book, Introducrion IO Seuropsychology. T.
MCMILLAS
E. ZARKOWSKA and J. CLEMENTS:Problem Behaciour in People with Severe Learning Disabilities. Croom Helm, London (1988). xi + 180 pages. f10.95. This is a very readable book, based on real-life situations, reflecting the authors’ extensive ‘hands on’ experience with both children and adults. The authors take an overall view in accepting the contributions of chemical intervention, socially orientated and behavioural approaches. They point out that adherence to just one strategy will result in limited effectiveness, and recommend a ‘multi-component’ approach. They recognise that this approach requires considerable time
BOOKREVIEWS
589
and manpower, plus careful attention to or8anisational issues; these requirements are all too often hard to come by, but at the least this book provides clear goals to aim at. and the simple graphics throughout the book clearly summarise the recommended strategies. It is regrettable that by espousing the acronym S.T.A.R. (Settings, Triggers, Actions and Results). the authors appear unaware of Chris Williams’s S.T.A.R. (Social Training Achievement Record), thus the two might collide with resulting confusion. The chapters on teaching skills and enhancing existing skills are very comprehensive, the programmes being set out in a series of logical steps. As the theme of the book is the long term management of unacceptable behaviours, emphasis is placed on the necessity to compete these out by more acceptable alternative skills. A later chapter discusses ways to encourage self-management. a very desirable but difficult goal to attain. As well as much practical advice, the authors helpfully address organisational and ethical issues. Their programmes require a very active commitment by the service agency and the carers, who must create an effective ‘multi~om~nent’ team who can give each other the support and encouragement essential for the long term (but rewarding) work which such programmes demand. In summary, this book could join the all too short list which is readable, reliable and realistic. It contains a great deal of useful information, conveyed in a sensible and interesting way. By no means the least sensible aspect is that it eschews the esoteric but often plain confusing term ‘challenging’, and more comprehensibly describes certain hhaviours as problems. Problems are made to be solved: this book provides a great many solutions, at a very reasonable price. E. C.
WRIGHT
and S. C. BEIDEL: TrearingObsessive-Compulsil~e Disorder. Pergamon Press, New York (1988). ix + 128 pages. Paperback f9.25; Hardback f 16.50.
S. M. TURNER
This book aims to provide clinicians with an up to date account of effective treatment strategies for obsessive-compulsive disorder, to help those with an appropriate background to implement treatment, and to provide students and trainees with an introduction to the area. Remarkably, within a fairly compact volume, all three aims are achieved very well indeed. Discussions of the phenomenology, differential diagnosis and a review of the clinical literature are lucid, objective and comprehensive. The assessment and treatment sections are sufficiently detailed and practical to act as guides to trainee therapists although the treatment approach used by the authors is an unusually rapid, hospital-based one with a greater emphasis on staff involvement in response prevention than is usual these days. However, alternative styles of delivery of behaviour therapy are discussed. Finally, this is one of those rare books which can be recommended to trainees without the need for a series of caveats and qualifiers. BOB MCDONALD
BRIDGE, A. F. MIRSKY and F. K. GWDWIN (Eds): Ps.~chological, Neuropsycbiat~~c and Substance Abuse Aspects of AIDS. Raven Press, New York (1988). xxv + 261 pages. S37.50.
T. P.
This book is aimed at researchers studying the immune, virologic and CNS mediated mechanisms of HIV. What it sets out to do is present a series ofchapters, collectively arguing that the success of developing treatment and preventive measures must include the fields of neuroscience, behaviour and substance abuse. To this end the book, comprising a total of twenty-four chapters, seems to fall into four sections. The first looks at the immune system and its relationship with the CNS, describing its molecular components and neuroendocrine properties. Whilst clearly written, a basic understanding of neuroanatomy is necessary. The second section examines the neuropsychiatric aspects of HIV disease and opens with a chapter presenting various models describing the psychiatric sequelae of AIDS. There is an interesting chapter by Cohen examining the biological mechanisms associated with psychological and emotional states-in particular, despair, depression and hopelessness. These are discussed in relation to an immunological response. By way of illustration, Cohen makes an interesting analogy between the bio-psychosocial interactions seen in AIDS to those observed in Vodoo. The third section addresses co-factors in host susceptibility to HIV and disease outcome, including cocaine, opiates, alcohol and gender differences. Discussion regarding the possible mechanisms through which such co-factors operate is particularly good in this section. The finai section reflects and brings together the preceding chapters by presenting a bio-psychosocial approach to AIDS which is multi-factorial. This model acknowledges the interaction of genetic, behavioural, situational and cultural factors, and highlights the considerable methodological problems encountered in this area of research. In an excellent opening chapter to this section, Temoshock presents preliminary outcome data from a longitudinal psychological study of men with AIDS and ARC and discusses the relationship of psychological variables to disease outcome. With the exception of the last, other chapters in the final section examine behavioural and psychosocial modulators of immunocompetence and are of a consistently high standard. The final chapter, which discusses legal and ethical issues surrounding HIV. does not tit easily with either the other chapters or the scope of the book. In conclusion, this book makes a valuable contribution to the literature. MARY BURGESS