Samuel M. Turner – författare

Recent advances in behavioral and biological treatments have raised the hopes and expectations of patients and clinicians alike in regard to obsessive-compulsive disorder-one of the most disabling, crippling, and resistant conditions in psy­ chiatry. In addition to their therapeutic efficacy, these new treatments have also opened new conceptual perspectives, thus complementing the traditional psychological theories of obsessive-compulsive disorder. Therefore, it is timely for these various conceptual frameworks and the treatment modalities they engender to be integrated and synthesized in the pres­ ent volume. To this end, eminent scholars in their respective areas were invited to contribute to this book, which we hope will symbolize and-in some measure-actualize the spirit of collaboration required if we are to fully comprehend the com­ plex nature of this disorder as well as to address existing ther­ apeutic challenges. In Chapter 1, Rachman sets the stage by providing an overview of the conceptual and therapeutic issues of obsessive-compulsive disorder. This is followed by an in­ depth review of the behavioral interventions from which Foa vii viii PREFACE and colleagues successfully distill the specific therapeutic processes of exposure and response prevention. In the third chapter, Sifneos deals with the psychodynamic factors under­ lying obsessive-compulsive phenomena and details his in­ novative technique of brief, anxiety-provoking psychotherapy aimed specifically at the obsessional state.

The most up-to-date coverage on adult psychopathology

Adult Psychopathology and Diagnosis, Fifth Edition offers comprehensive coverage of the major psychological disorders and presents a balanced integration of empirical data and diagnostic criteria to demonstrate the basis for individual diagnoses. The accessible format and case study approach provide the opportunity to understand how diagnoses are reached.

Updated to reflect the rapid developments in the field of psychopathology, this Fifth Edition encompasses the most current research in the field including:

A thorough introduction to the principles of the DSM-IV-TR classification system and its application in clinical practice The biological and neurological foundations of disorders and the implications of psychopharmacology in treatment Illustrative case material as well as clinical discussions addressing specific disorders, diagnostic criteria, major theories of etiology, and issues of assessment and measurement Coverage of the major diagnostic entities and problems seen in daily clinical work by those in hospitals, clinics, and private practice A new chapter on race and ethnicity by renowned expert Stanley Sue

Contemporary behavior therapy encompasses diverse conceptual positions, clinical and applied problems, and intervention techniques. Behavior therapy has spread to several disciplines to provide substantive concepts and procedures as well as methodological tenets regarding how intervention techniques are to be evaluated. The proliferation of behavior therapy research has produced a plethora of texts. Typically texts review the history of particular treatments and detail contemporary advances. The historical underpinnings are often emphasized with the heavily labored view that in order to understand where one is going, it is important to understand where one has been. To be sure, historical roots of behavior therapy are important to document. However, a given history might have many different outcomes. Similarly, the current status of par­ ticular areas is frequently reviewed. Sometimes the number of reviews seems to approach or exceed the number of sound studies that there are to be reviewed. A review of current work is obviously essential but leaves open major questions of where the work will all lead. A valuable addition to ex­ isting reviews would be information that points in a prescriptive or explicit way to areas that are likely to be important in future work. The present book is unique in its approach and focus. Brief reviews of contemporary advances are provided in diverse areas of behavior therapy and serve as a point of departure to chart emerging trends and future direc­ tions.

Contemporary behavior therapy encompasses diverse conceptual positions, clinical and applied problems, and intervention techniques. Behavior therapy has spread to several disciplines to provide substantive concepts and procedures as well as methodological tenets regarding how intervention techniques are to be evaluated. The proliferation of behavior therapy research has produced a plethora of texts. Typically texts review the history of particular treatments and detail contemporary advances. The historical underpinnings are often emphasized with the heavily labored view that in order to understand where one is going, it is important to understand where one has been. To be sure, historical roots of behavior therapy are important to document. However, a given history might have many different outcomes. Similarly, the current status of par­ ticular areas is frequently reviewed. Sometimes the number of reviews seems to approach or exceed the number of sound studies that there are to be reviewed. A review of current work is obviously essential but leaves open major questions of where the work will all lead. A valuable addition to ex­ isting reviews would be information that points in a prescriptive or explicit way to areas that are likely to be important in future work. The present book is unique in its approach and focus. Brief reviews of contemporary advances are provided in diverse areas of behavior therapy and serve as a point of departure to chart emerging trends and future direc­ tions.

During the past decade, research and practice in the field of behavior modification have experienced phenomenal growth. Behavioral inter­ vention strategies that were considered strictly experimental a few years ago are now accepted therapeutic modalities, and behavioral method­ ology has been instrumental in creating an atmosphere conducive to the development of scientific rigor in the area of mental health. But behav­ ioral influence has not been limited to mental health. There has been considerable impact in education, industry, government, and general health care. Although behavior modification has made a significant impact on psychology in general, there has been a noticeable lack of theorizing and empirical research on issues primarily related to black populations. In fact, the black community in general, and black psychologists in partic­ ular, often have viewed behavioral approaches with suspicion. We hope that the material presented in this volume will serve to clarify what the behavioral approach is and what it is not and that it will help to foster an understanding of the behavioral approach. Moreover, empirical data demonstrating the effectiveness of behavioral procedures with black populations are presented. It is our hope that the material will provide some insight into how behavioral theory, methodology, and therapeutic strategies can be used to the benefit of black mental health in particular and the overall psychological health of the black community in general.

During the past decade, research and practice in the field of behavior modification have experienced phenomenal growth. Behavioral inter­ vention strategies that were considered strictly experimental a few years ago are now accepted therapeutic modalities, and behavioral method­ ology has been instrumental in creating an atmosphere conducive to the development of scientific rigor in the area of mental health. But behav­ ioral influence has not been limited to mental health. There has been considerable impact in education, industry, government, and general health care. Although behavior modification has made a significant impact on psychology in general, there has been a noticeable lack of theorizing and empirical research on issues primarily related to black populations. In fact, the black community in general, and black psychologists in partic­ ular, often have viewed behavioral approaches with suspicion. We hope that the material presented in this volume will serve to clarify what the behavioral approach is and what it is not and that it will help to foster an understanding of the behavioral approach. Moreover, empirical data demonstrating the effectiveness of behavioral procedures with black populations are presented. It is our hope that the material will provide some insight into how behavioral theory, methodology, and therapeutic strategies can be used to the benefit of black mental health in particular and the overall psychological health of the black community in general.

When behavior therapy was first applied to what would now be labeled an anxiety disorder, a simplistic theoretical model guided the treatment of a sim­ ple phobia. Time and research have shown that the techniques of behavior ther­ apy have been more successful than its models have been explanatory. Yet progress has been substantial in both realms, as the following volume makes patently clear. In 1980 an inventory of this progress was catalogued at an NIMH-sponsored workshop. What both that workshop and this volume clearly show is that the behav­ ior therapy researcher need no longer suffer the epithet "overly simplistic." One of the major strengths of this volume is its elucidation of the complexities that now attend the study of the anxiety disorders, particularly from a behav­ ioral point of view. The researcher at times appears almost to be buried in a landslide of complexities regarding this topic. The concept of anxiety itself has undergone a differentiation to a level of complexity that poses problems for both the conceptualization and the treat­ ment of anxiety disorders. In virtually one voice, the several authors of this volume argue the multidimensional nature of anxiety. The "lump" view of anx­ iety has given way to the three-channel view of anxiety. An investigator''s future research career could well be secured just by spending time puzzling out the significance of the low intercorrelations among the channels.

When behavior therapy was first applied to what would now be labeled an anxiety disorder, a simplistic theoretical model guided the treatment of a sim­ ple phobia. Time and research have shown that the techniques of behavior ther­ apy have been more successful than its models have been explanatory. Yet progress has been substantial in both realms, as the following volume makes patently clear. In 1980 an inventory of this progress was catalogued at an NIMH-sponsored workshop. What both that workshop and this volume clearly show is that the behav­ ior therapy researcher need no longer suffer the epithet "overly simplistic." One of the major strengths of this volume is its elucidation of the complexities that now attend the study of the anxiety disorders, particularly from a behav­ ioral point of view. The researcher at times appears almost to be buried in a landslide of complexities regarding this topic. The concept of anxiety itself has undergone a differentiation to a level of complexity that poses problems for both the conceptualization and the treat­ ment of anxiety disorders. In virtually one voice, the several authors of this volume argue the multidimensional nature of anxiety. The "lump" view of anx­ iety has given way to the three-channel view of anxiety. An investigator's future research career could well be secured just by spending time puzzling out the significance of the low intercorrelations among the channels.

Perhaps the most difficult milestone in a young clinician''s career is the completion of the first interview. For the typical trainee, the endeavor is fraught with apprehen­ sion and with some degree of dread. If the interview goes weIl, there is consider­ able rejoicing; if it goes badly, much consternation results. Irrespective of the amount of preparation that has taken place before the interview, the neophyte will justifiably remain nervous about this endeavor. Thus, the first edition of Diagnostic Interviewing was devoted to providing a clear outline for the student in tackling a large variety of patients in the interview setting. In consideration of the positive response to the first edition of Diagnostic Interviewing, published in 1985, we and our editor at Plenum Press, Eliot Werner, decided that it was time to update the material. However, the basic premise that a book of this nature needs to encompass theoretical rationale, clinical description, and the pragmatics of "how to"once again has been followed. And, as in the case of the first edition, this second edition does not represent the cat''s being skinned in yet another way. Quite to the contrary, we still believe that our students truly need to read the material covered herein with considerable care, and once again the book is dedicated to them. We are particularly concerned that in the clinieal education of our graduate students, interviewing has been given short shrift.

Recent advances in behavioral and biological treatments have raised the hopes and expectations of patients and clinicians alike in regard to obsessive-compulsive disorder-one of the most disabling, crippling, and resistant conditions in psy­ chiatry. In addition to their therapeutic efficacy, these new treatments have also opened new conceptual perspectives, thus complementing the traditional psychological theories of obsessive-compulsive disorder. Therefore, it is timely for these various conceptual frameworks and the treatment modalities they engender to be integrated and synthesized in the pres­ ent volume. To this end, eminent scholars in their respective areas were invited to contribute to this book, which we hope will symbolize and-in some measure-actualize the spirit of collaboration required if we are to fully comprehend the com­ plex nature of this disorder as well as to address existing ther­ apeutic challenges. In Chapter 1, Rachman sets the stage by providing an overview of the conceptual and therapeutic issues of obsessive-compulsive disorder. This is followed by an in­ depth review of the behavioral interventions from which Foa vii viii PREFACE and colleagues successfully distill the specific therapeutic processes of exposure and response prevention. In the third chapter, Sifneos deals with the psychodynamic factors under­ lying obsessive-compulsive phenomena and details his in­ novative technique of brief, anxiety-provoking psychotherapy aimed specifically at the obsessional state.