This book is authored by Kate V. Hardy and Douglas Turkington. Hardy is an experienced psychologist working with people with psychosis in research and clinical settings in the UK and USA. Turkington is a Consultant Psychiatrist and Professor in Psychosocial Psychiatry working for the NHS. The vast experience and expertise of both authors shines through in this book. Furthermore, more than 20 international authors also lend their expertise and insights on various topics throughout the book. This book is a valuable addition to the literature already available on the topic of understanding and treating delusions.

The book is divided into 3 sections; Delusions, treating delusions, and working with delusions in different settings. Case examples are utilised throughout the book. There are links to available online video clips throughout the book to help illustrate treatment modalities and demonstrate key skills to interested readers. The first part of the book tackles the challenging issue of trying to differentiate between the ‘madness of crowds’ and delusions. It uses historic, social, and cultural phenomena to help differentiate the two. It talks about conspiracy theorists who believe the moon landing was faked or the emergence of Qanon, a far-right American political conspiracy theory that a cabal of Satanic, cannibalistic child molesters is operating a global child sex trafficking ring that conspired against president Donald Trump, as examples of the madness of crowds or unusual beliefs of ordinary people. This helps the reader think about this quandary in real terms and how it presents itself in our day to day practice. This part of the book also addresses what it means to believe and the importance of the human capacity for language when it comes to believing. It suggests that beliefs are rooted in an individuals lived reality and life history and that clinicians should spend more time trying to understand the basis for patients’ beliefs. These initial chapters are extremely useful to any clinician working in mental health but particularly to clinicians early in their career. They task us to think deeply about our understanding of delusions and beliefs and suggest we try understand a patient’s life story rather than simply ticking off symptomatology.

Chapters 5 and 6 are very practical and useful chapters. I would advise any busy clinician who does not have time to read the full book to read these chapters. Chapter 5 discusses linguistic techniques and strategies for communicating with patients with delusions and thought disorder. The technique I felt was most applicable to everyday practice was ‘adapted transitivity analysis’. This basically means breaking down what a patients says into core components. Table 5.1 provides a simple summary of how to do this. Chapter 6 offers useful tips and strategies for assessing delusions. The fundamental message is that natural gentle questioning and a good therapeutic relationship are key components of an assessment. Table 6.1 is very useful and lists the core aspects of a delusion which should be assessed.

The second part of the book deals with treating delusions. The key message is that collaboration without collusion or confrontation with the patient is best practice. It discusses some of the important strategies cognitive behavioural therapy (CBT) therapists use when treating psychosis such as befriending, normalising and curious questioning. It also discusses specific types of delusions; sexual delusions, delusions of misidentification, delusions arising from trauma, etc. I found the chapter on trauma and delusions very informative. It suggests that in the case of trauma, delusions may be linked to evolutionary processes to help people detect and react to social threats and that these delusions may serve a purpose to keep the person safe in the immediate term by developing a pattern of hypervigilance and avoidance. This is a very interesting theory, and it encourages us to always view trauma-based delusions through a trauma lens. Given many patients presenting to mental health services have experienced trauma this is an important takeaway from the book.

The final part of the book addresses working with delusions in different settings; forensic, digital, patient families. As a trainee psychiatrist, I found the chapter on CBT informed skills training for families the most useful. It suggests simple, CBT informed skills families can use to try help support their loved one experiencing delusions.

At times this book is somewhat critical of the status quo in terms of current treatment and management of psychosis. Chapter two provides an example of the lived experience of strongly held beliefs. It suggests that our current systems and processes can sometimes re traumatise patients and reinforce persecutory beliefs. Although this is unfortunately sometimes true, particularly in the case of involuntary admissions, mental health teams (MHTs) are compelled to work within the legal system of their country and with the resources available. Similarly, the book is sometimes critical of what is perceived as an overly biological approach to treatment of psychosis. Again I think for most MHTs this is the result of circumstance rather than choice. In Ireland MHTs have limited access to clinicians trained in CBT for psychosis (CBT-P). Ideally, all patients would have access to this very valuable resource. This also serves to prove the usefulness of this book. As many MHTs don’t have CBT-P specialists available, it is important that all members of the team acquire some basic understanding of the core concepts of CBT-P.

This book is aimed towards clinicians who are providing CBT for psychosis; however, I think the book is relevant to any mental health provider working with patients with psychosis. Firstly, the content of the book is largely accessible and not overly academic. The use of tables for summarising information is a highlight of this book. The provision of instructional videos that can be accessed online is an additional bonus. Secondly, I think the book reinforces key concepts such as the value of therapeutic rapport and the importance of being naturally curious about patients. Thirdly, it is important that everyone working with patients experiencing psychosis understands the basic principles of CBT-P in the interest of maintaining therapeutic rapport. I would recommend this book to anyone regularly interacting with patients experiencing psychosis.