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Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: a treatment manual Sabine Wilhelm, Katherine A. Phillips and Gail Steketee New York: Guilford Press, 2013. pp. 320, £28.99 (pb). ISBN: 978-1-4625-0790-0.

Wilhelm and colleagues have produced a very well structured and comprehensive cognitivebehavioural manual for the treatment of body dysmorphic disorder in adults. They refer readers to Greenberg et al. (2010) for modifications required in the treatment of younger patients. The authors intend the manual for therapists who have training and experience in CBT. The level of step-by-step detail that is provided on session structure and content make it a very useful guide for less experienced therapists, while the organizational clarity of the manual makes it an accessible reference resource for the more experienced therapist. The manual contains 18 chapters divided into 4 sections. Section 1 covers the fundamentals of body dysmorphic disorder and its treatment, including definitions, diagnosis, special considerations in treating BDD, enhancing motivation and a treatment overview. Section 2 covers the introductory treatment sessions, including CBT assessment, case formulation and goal setting. Section 3 covers the core treatment components in 6 chapters. These are evaluating self-defeating thoughts, exposure, ritual prevention, perceptual retraining for mirror checking, advanced cognitive strategies (core belief work), and termination/relapse prevention and booster sessions. Section 4 covers the optional modules of skin-picking and hair-pulling, weight, shape and muscularity, cosmetic treatment, and depression. The theoretical orientation of the treatment manual is both cognitive and behavioural. While there are dedicated chapters on thought challenging and core belief work there is also a significant emphasis on behavioural interventions. Exposure tasks are designed as behavioural experiments in which the client tests out negative beliefs but, in line with behavioural principles, the exposure tasks are approached in a hierarchy of situations from the least to the most distressing, and they are introduced with a behavioural rationale of habituation. Within the chapter on ritual prevention the difference between safety behaviours (a cognitive concept meaning behaviours that are performed to prevent negative outcomes) and compulsive behaviours (a behavioural concept meaning behaviours that are performed to reduce or undo negative feelings), is not made explicit, and behavioural experiments are integrated into exposure tasks rather than being treated separately. This contrasts with the cognitive behavioural manual on body dysmorphic disorder developed by Veale and Neziroglu (2010) which distinguishes as separate treatment components graded exposure (with response prevention) from behavioural experiments (without safety behaviours), and where the whole therapy is framed in terms of the cognitive testing out of two alternative theories of what the problem is (whether one of appearance or worry). There is a relatively stronger emphasis on behavioural interventions in the manual under review in comparison with the more cognitive emphasis in the manual by Veale and Neziroglu (2010). Another difference between the two manuals is that the treatment programme by Veale and Neziroglu (2010) places emphasis