BOOK REVIEWS 589

and manpower, plus careful attention to or8anisational issues; these requirements are all too often hard to come by, but at the least this book provides clear goals to aim at. and the simple graphics throughout the book clearly summarise the recommended strategies. It is regrettable that by espousing the acronym S.T.A.R. (Settings, Triggers, Actions and Results). the authors appear unaware of Chris Williams’s S.T.A.R. (Social Training Achievement Record), thus the two might collide with resulting confusion.

The chapters on teaching skills and enhancing existing skills are very comprehensive, the programmes being set out in a series of logical steps. As the theme of the book is the long term management of unacceptable behaviours, emphasis is placed on the necessity to compete these out by more acceptable alternative skills. A later chapter discusses ways to encourage self-management. a very desirable but difficult goal to attain.

As well as much practical advice, the authors helpfully address organisational and ethical issues. Their programmes require a very active commitment by the service agency and the carers, who must create an effective ‘multi~om~nent’ team who can give each other the support and encouragement essential for the long term (but rewarding) work which such programmes demand.

In summary, this book could join the all too short list which is readable, reliable and realistic. It contains a great deal of useful information, conveyed in a sensible and interesting way. By no means the least sensible aspect is that it eschews the esoteric but often plain confusing term ‘challenging’, and more comprehensibly describes certain hhaviours as problems. Problems are made to be solved: this book provides a great many solutions, at a very reasonable price.

E. C. WRIGHT

S. M. TURNER and S. C. BEIDEL: Trearing Obsessive-Compulsil~e Disorder. Pergamon Press, New York (1988). ix + 128 pages. Paperback f9.25; Hardback f 16.50.

This book aims to provide clinicians with an up to date account of effective treatment strategies for obsessive-compulsive disorder, to help those with an appropriate background to implement treatment, and to provide students and trainees with an introduction to the area.

Remarkably, within a fairly compact volume, all three aims are achieved very well indeed. Discussions of the phenomenology, differential diagnosis and a review of the clinical literature are lucid, objective and comprehensive. The assessment and treatment sections are sufficiently detailed and practical to act as guides to trainee therapists although the treatment approach used by the authors is an unusually rapid, hospital-based one with a greater emphasis on staff involvement in response prevention than is usual these days. However, alternative styles of delivery of behaviour therapy are discussed.

Finally, this is one of those rare books which can be recommended to trainees without the need for a series of caveats and qualifiers.

BOB MCDONALD

T. P. BRIDGE, A. F. MIRSKY and F. K. GWDWIN (Eds): Ps.~chological, Neuropsycbiat~~c and Substance Abuse Aspects of AIDS. Raven Press, New York (1988). xxv + 261 pages. S37.50.

This book is aimed at researchers studying the immune, virologic and CNS mediated mechanisms of HIV. What it sets out to do is present a series ofchapters, collectively arguing that the success of developing treatment and preventive measures must include the fields of neuroscience, behaviour and substance abuse. To this end the book, comprising a total of twenty-four chapters, seems to fall into four sections.

The first looks at the immune system and its relationship with the CNS, describing its molecular components and neuroendocrine properties. Whilst clearly written, a basic understanding of neuroanatomy is necessary.

The second section examines the neuropsychiatric aspects of HIV disease and opens with a chapter presenting various models describing the psychiatric sequelae of AIDS. There is an interesting chapter by Cohen examining the biological mechanisms associated with psychological and emotional states-in particular, despair, depression and hopelessness. These are discussed in relation to an immunological response. By way of illustration, Cohen makes an interesting analogy between the bio-psychosocial interactions seen in AIDS to those observed in Vodoo.

The third section addresses co-factors in host susceptibility to HIV and disease outcome, including cocaine, opiates, alcohol and gender differences. Discussion regarding the possible mechanisms through which such co-factors operate is particularly good in this section.

The finai section reflects and brings together the preceding chapters by presenting a bio-psychosocial approach to AIDS which is multi-factorial. This model acknowledges the interaction of genetic, behavioural, situational and cultural factors, and highlights the considerable methodological problems encountered in this area of research. In an excellent opening chapter to this section, Temoshock presents preliminary outcome data from a longitudinal psychological study of men with AIDS and ARC and discusses the relationship of psychological variables to disease outcome. With the exception of the last, other chapters in the final section examine behavioural and psychosocial modulators of immunocompetence and are of a consistently high standard. The final chapter, which discusses legal and ethical issues surrounding HIV. does not tit easily with either the other chapters or the scope of the book.

In conclusion, this book makes a valuable contribution to the literature.

MARY BURGESS