This book is dedicated to the prodromal stage of psychosis, termed the “At Risk Mental State” (ARMS) and is written by leading clinicians and researchers in this field. The book is split into two parts: Part I details theory and evidence surrounding ARMS and Part II outlines treatment using a specifically developed CBT treatment protocol. The Appendix has copies of all the relevant treatment forms.

Taking the first section of the book, chapters start by explaining what clinical features constitute an ARMS and how early identification may help in the prevention of transition to psychosis. It explains the assessment tools used to detect ARMS, focusing mainly on the Comprehensive Assessment of At Risk Mental States (CAARMS). Helpfully, it details some case vignettes to explain how subjects may score on the CAARMS. The main bulk of Part 1 focuses on the cognitive biases thought to be associated with ARMS, taking each one individually and illustrating it with a case example before providing a review of the research evidence. The reader is then presented with research surrounding the treatment of biases, which suggests that although feasible with some positive outcomes, several studies have found results that are nonsignificant. Part 1 finishes with the evidence for early detection and specifically details the results from a Dutch RCT that compared CBT against TAU in ARMS. Results suggest CBT can be effective in preventing psychosis; however it is unclear which parts of treatment are associated with mechanisms of change.

The second stage of the book provides suggested techniques that can be included in the CBT package. Part 2 is designed as a treatment protocol with extracts from therapist sessions to illustrate what the dialogue might look like in sessions. The book comes with a web address to download the therapy manual, which includes psycho-education material and session forms. The protocol proposes that there are nine stages to treatment: 1) introduction; 2) pre-assessment; 3) psycho-education and normalizing; 4) CBT assessment and metacognitive training; 5) case formulation and goal setting; 6) CBT intervention; 7) post-assessment; 8) consolidation; and 9) booster sessions. The manual's focus is on coping with “extraordinary experiences” through normalization, assessment, formulation and treatment. Psycho-education focuses specifically on the prevalence and types of extraordinary experiences, the role of dopamine dysregulation and the influence of beliefs. The manual allows patients to have print-outs explaining this. The CBT assessment revolves around the ABC model, which identifies the Activating event, automatic thoughts and interpretations (Beliefs) and Consequences (both emotional and behavioural). Metacognitive training (MCT) follows, where psycho-education on cognitive biases is discussed and homework exercises are set up so patients can see the daily impact of biases. Making this idiosyncratic to the patient is the final part of MCT. Some information is provided on what might make extraordinary experiences more dominant, including a model of depersonalization, neural mechanisms that could explain feelings of having thoughts and behaviour controlled, the role avoidance plays in turning suspicion to paranoia, and proposed neural explanations of voices that can be maintained by negative emotions.

As information is gathered through initial sessions the manual then outlines how to develop the case formulation and set goals. By drawing out the ABC model patients are shown the role their beliefs can play, adding in relevant life experiences and possible predispositions that influence not only symptoms but core beliefs and assumptions. Treatment focuses on cognitive challenging of beliefs through generation of alternate explanations, pie charts and behavioural experiments. Strategies are well explained through extracts, tips and case vignettes, allowing the reader to understand the use of the strategy in clinical practice. The manual finishes with recompleting the measures, relapse prevention and possible booster sessions spread out monthly. The final chapter is dedicated to typical case vignettes outlining different presenting problems and what the course of treatment would look like in practice.

In summary the book is well presented and easy to read. The vignettes and session extracts bring the techniques to life and guide the reader in formulating different complexities. The psycho-educational material is unique compared to other CBT textbooks, training the clinician in normalization of the patient's experiences. Having the option to download the manual means this information can then be shared with patients, depending on levels of literacy. The reader may have differing opinions on the chapters dedicated to biases and metacognitive training depending on their interest in this area. However, there is enough information within the book to hopefully please every reader.