A recent advance has been the development of briefer and simpler forms of cognitive-behaviour therapy. This has been facilitated by the availability of a number of cognitive-behavioural self-help books.(1. 14 and !.5> These books may be used in various ways as follows.
1. To facilitate cognitive-behaviour therapy. Two of the books are directly based on cognitive-behaviour therapy for bulimia nervosa. (1, 14) They provide the information patients need in the course of treatment together with guidelines for the implementation of the simpler behavioural and cognitive procedures. Therefore they may be used to facilitate therapist-led treatment.
2. To allow treatment by non-specialist therapists. Cognitive- behaviour therapy is a specialist treatment which limits its dissemination. For some patients 'guided self-help' is a viable alternative to cognitive-behaviour therapy. This involves following a cognitive-behavioural self-help programme with support from a non-specialist 'facilitator'. (18> Since this form of treatment is programme led rather than therapist led, it is suitable for use in primary care and other non-specialist settings.
3. As a form of 'pure self-help'. The cognitive-behavioural self-help books also have the potential to be used on their own with no professional input. As yet, there has been only one study of pure self-help but its findings were encouraging. (!8>
The issue of training has not been studied but it deserves to be. On the basis of the author's experience supervising the therapists in a number of treatment trials, attending a training workshop is of value especially if this is followed by ongoing case supervision. If possible, the supervisor should listen to audiotapes of sample treatment sessions rather than rely exclusively on the trainee's report of what happened. Some prior experience in cognitive-behaviour therapy is an advantage but is by no means essential.
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