Hallucinations: A Guide to Treatment and Management Edited by Frank Larøi & André Aleman, Oxford University Press, 2010, £44.95, hb, 416 pp. ISBN: 9780199548590
This is an ambitious book that brings together the clinical and research experience of a wide range of international leading experts, mainly European, on the field of hallucinations. Its main aim is to provide an insightful understanding of these multifaceted experiences and to offer a practical guide to their assessment and treatment in day-to-day clinical practice. For this, the book has a practical orientation, focusing on the available intervention strategies, mainly psychological, and
... ation methods, incorporating when needed clinical vignettes and case samples. The treatment and evaluation protocols proposed are backed up by empirical evidence of their efficacy. From a general perspective of analysis, the book has two main conceptual problems in its structure. The first one is its almost exclusive focus on a psychological perspective. Although this is understandable from a research point of view, the case is that in day-to-day clinical practice the main strategies of intervention are biological. This one-sided orientation is compounded by the absence of reference to an integrated (biological and psychological) model of treatment in the chapters devoted to psychological interventions. This is revealing, as in today's clinical practice very rarely are these interventions used in isolation for the treatment of hallucinations. The second problem is the lack of a conceptual framework to integrate the many different intervention strategies described. Despite these limitations, the book covers a wide spectrum of interventions, ranging from the biological to the psychosocial polarity. At the biological end it includes a very good and comprehensive chapter on the pharmacological treatment of hallucinations, and also a chapter concerning the emerging use of transcranial magnetic stimulation in hallucinations. But where the book is particularly strong is in discussing the psychosocial perspective, with numerous types of psychological interventions, at both the individual and group level. Of special interest are the chapters dedicated to cognitive-behavioural therapy, attention training technique, acceptance and commitment therapy, competitive memory training, hallucinations-focused integrative therapy, and coping strategies to reduce the negative impact that hallucinations have on patients. In addition, it also incorporates comprehensive chapters dedicated to a particular type of verbal hallucinations, 'command hallucinations', and also to hallucinations in the context of particular clinical situations. Finally, the book ends with a comprehensive chapter on the assessment of hallucinations. In summary, this book makes available very extensive, updated and useful information for the evaluation and treatment of hallucinations, focusing mainly on the psychological strategies of treatment. The information provided is very clear and practical and should be of great utility for practising clinicians. The book is divided into four parts, starting off with a section on cognitive models of auditory hallucinations and delusions and on the assessment of psychosis. The initial chapters summarise the cognitive models of auditory hallucinations and delusions and discuss how these models can inform clinical practice. The next chapter describes in detail the areas of assessment for cognitive-behavioural therapy (CBT) in psychosis and uses case examples to illustrate how the assessment instruments discussed can be applied in daily practice. The next part provides detailed descriptions of typical treatment components involved in CBT for psychosis, including the therapeutic alliance, the use of normalising and relapse prevention. It also covers more specific skills and techniques to perform CBT in early intervention, with command hallucinations and with people experiencing residual negative symptoms. The book also addresses the issues associated with implementing CBT for psychosis when resources are limited and describes a number of possible solutions such as the use of a structured manual or delivering CBT in a group format. Part three starts with two chapters on how to integrate CBT in the treatment of people with psychosis and substance misuse, and in people experiencing a first episode of psychosis who have experienced a traumatic life event. These are followed by an interesting chapter on how to integrate the family in the treatment of psychosis and ends with an outline of how CBT can be applied to improve work outcome in people with severe mental health problems. The final section of the book describes the implementation of CBT in the treatment of bipolar disorders. This section is more theoretical and, regrettably, does not use clinical vignettes like the previous chapters. Overall, the book presents material on CBT for psychosis in an easy and understandable way and has practical illustrations of the theory. It is comprehensive, accessible and I would recommend it to clinicians working with people with psychosis.