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The Treatment of Anxiety Disorders: Clinician's Guide and Patient Manuals
Donald F. Klein, M.D.
Am J Psychiatry 1998;155:143a-144.
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New York, N.Y.

by Gavin Andrews, Rocco Crino, Caroline Hunt, Lisa Lampe, and Andrew Page. New York, Cambridge University Press, 1994, 410 pp., $89.95; $39.95 (paper).

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This interesting book is only partially successful as an authoritative review of the epidemiology, etiology, evaluation, and treatment of anxiety disorders. The authors state that the book will help clinicians understand the nature of the disorders and consider treatment options and that it is "fully referenced." It includes separate clinician's guides and patient treatment manuals for each disorder. The clinician's guides contain advice about patient characteristics, developing a treatment program, and critical issues in the treatment process. The patient treatment manuals are designed for direct collaborative use with patients to help the patient understand and carry out the treatment. The illnesses covered are panic disorder and agoraphobia, social phobia, specific phobias, obsessive-compulsive disorder, generalized anxiety disorder, adjustment disorder, posttraumatic stress disorder, and secondary anxiety. Each subsection successively considers the syndrome, the treatment, the clinician's guide, and the patient treatment manual.

However, the book is distinctly skimpy with regard to the range of pathogenic theories, differential diagnosis, and the need for a proper initial medical evaluation. Not until the book's end is there is any mention that anxiety may be secondary to physical illness. The limitations of the therapeutic database are also discussed only in the final pages.

There is no critical discussion of the relative merits and lack of merit of alternative treatments. For instance, in the section on the treatment of social phobia, there is a brief discussion of β blockers, benzodiazepines, monoamine oxidase inhibitors, and other pharmacological agents. However, in the clinician's guide section, there is no discussion of medication as an alternative or supplement, and in the patient treatment manual section there is only a dismissive statement with regard to benzodiazepines, which says that they work only for a little while, prevent a sense of self-mastery, and produce a high risk of dependence.

The field of anxiety studies and treatment is highly controversial. One would expect that statements contradicted by substantial data would bear discussion rather than mere assertion. For instance, the authors declare that hyperventilation causes shortness of breath, although there is substantial debate concerning whether hyperventilation causes dyspnea or dyspnea causes hyperventilation.

The book is clearly written. For a clinician who has already carried out an appropriate differential diagnosis and has decided to use cognitive behavior techniques exclusively, it is a useful, concrete discussion. Including patient treatment manuals that the purchaser is free to copy and distribute to his or her patients is handy and fosters a thoughtful collaboration between clinician and patient.




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