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Psychopathology From Science to Clinical Practice.

2014; Lippincott Williams & Wilkins; Volume: 202; Issue: 10 Linguagem: Inglês

10.1097/nmd.0000000000000192

1539-736X

Radu V. Saveanu,

Child and Adolescent Psychosocial and Emotional Development

This volume, edited by two well-established academic psychologists, provides the reader with an excellent integration of mental health research and clinical practice. The editors have assembled a terrific group of contributors with a wide range of expertise and orientations. This book attempts to bring together researchers and clinicians as well as to bridge some of the controversies that have divided them over the years. Clinicians often state that the scientific questions raised by researchers are not clinically relevant to them. They feel that their substantial clinical experience is frequently ignored or looked down upon. Clinicians claim that they are far more interested in the unique characteristics of their patients than in statistic averages and correlations. Researchers, on the other hand, feel ignored by clinicians who, they feel, may take a long time to adopt their findings into clinical practice. They also believe that clinicians tend to embrace the status quo of current knowledge, as opposed to finding new ways of understanding, treating, and hopefully preventing mental illness. This volume successfully brings to us up-to-date scientific knowledge and successfully translates it into useful and thoughtful clinical applications. It also provides a good overview of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classification, which will be useful to clinicians still struggling to incorporate the new revisions into their clinical practice. It was published in 2013, around the same time the DSM-5 came out, and includes the changes made to the new edition. As we all know, the DSM-5 classification and diagnostic criteria play a significant role in shaping treatment recommendations in clinical practice (certainly true in the United States). The DSM-5 has received its share of criticism from both the scientific and clinical communities. Critics have asserted that some revisions lack both empirical support and sufficient clinical evidence. This book steers clear of these controversies and tries to present the DSM-5 revision in a neutral even-handed way. This book has some unique features that I will illustrate with a couple of examples. In addition to a thorough discussion of symptoms that define various clinical diagnoses, it reviews evidence-based data on social and occupational functioning, cultural forces, emotional dysregulation, and others. These are domains that play a significant role in our understanding of psychopathology and its treatment. The book consists of 14 chapters covering a wide range of psychopathologies: depression, anxiety disorders, bipolar disorder, personality disorders, substance abuse, and schizophrenia, to list a few. Each chapter covers a particular disorder and uses a similar structure: a description of symptoms, clinical features, epidemiology, course, comorbidities, etiological factors, clinical implications, and evidence-based treatment approaches. Several chapters identify underlying principles of change that can be very useful to clinicians treating a variety of psychiatric conditions. For instance, the chapter on Panic Disorder and Phobias concludes with a useful summary of general principles of change. These principles include the following (p. 129): a) Expectation of a positive outcome b) Optimal therapeutic alliance c) Enhancing the patient’s psychological awareness d) Corrective experiences (e.g., via exposure) e) Reevaluation of biased thinking The authors believe that future research should focus on investigating specific indicators associated with the efficacy or effectiveness of these principles and incorporate these indicators into an evidence-based treatment approach to patients with various clinical presentations. The section on Depression describes several recent research findings that focus on the role of automatic processes such as cognitive inhibition and emotional dysregulation—in addition to the more traditional biological markers. The authors correctly indicate that these processes, although identified as potential determinants of depression, have not been thoroughly addressed in our current clinical approaches. As the authors state, “CBT for depression has undergone few changes in the past 50 years” (p. 18). The chapter goes on to describe six principles of change that could (and should) guide evidence-based practice for depression (p. 22). These principles include the following: a) Challenging cognition and behavior b) Increasing positive reinforcements c) Improving interpersonal functioning d)Improving marital, family, and social environment e) Fostering emotional awareness, acceptance, and regulation f)Providing a treatment that is both structured and focused I will give you an example from this volume that shows the necessary connection between theory and clinical encounter and ties into the principles of therapeutic change that I just explained. It has been postulated that one possible explanation for the steadily climbing prevalence of depression during the past few decades may be our societal “focus on individualism rather than the common good” (p. 28). This shift in focus makes it more difficult for individuals who are under significant stress or conflict to reach out for help and support. If this hypothesis is correct, our therapeutic interventions (to be optimally effective) should address each depressed patient’s individual functioning (especially attachment and communication problems) to improve his/her family and social environment. The book attempts to present current knowledge in a comprehensive way. The treatment section in most chapters is heavily focused on cognitive behavioral or behavioral therapies. Relatively little attention is given to other therapeutic approaches such as brief psychodynamic therapy or eye movement desensitization and reprocessing therapy (to mention a couple), even when efficacy data (albeit at times controversial) are available. Each chapter’s section on new biological findings is invariably short and incomplete, but the authors make it abundantly clear that this volume focuses primarily on psychological treatments. Each chapter has an extensive bibliography for readers who are interested in learning more about these topics. I found this book to be a valuable reference for clinicians and graduate students in psychology, social work, and psychiatry. Radu V. Saveanu, MD Department of Psychiatry & Behavioral Sciences University of Miami Leonard M. Miller School of Medicine Miami, FL DISCLOSURE The author declares no conflict of interest.