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Book Forum: Treatment Guides   |    
The Treatment of Anxiety Disorders: Clinician Guides and Patient Manuals, 2nd ed. ? The Anxiety Book: Developing Strength in the Face of Fear
Am J Psychiatry 2004;161:940-a-941. doi:10.1176/appi.ajp.161.5.940-a
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Rockville, Md.

By Gavin Andrews, Mark Creamer, Rocco Crino, Caroline Hunt, Lisa Lape, and Andrew Page. New York, Cambridge University Press, 2002, 624 pp., $60.00 (paper). • By Jonathan Davidson, M.D., and Henry Dreher. New York, Riverhead Books (Penguin Group), 2003, 320 pp., $24.95; $15.00 (paper).

Twenty years ago the anxiety disorders were orphans in the mental health field, widely seen as uncommon, trivial, and essentially untreatable. Serious researchers and clinicians focused on the affective disorders and schizophrenia. Over the past two decades, however, the anxiety disorders have gradually emerged from this neglect into their current status as a major focus of research and practice. Much of the credit for this change belongs to the Anxiety Disorders Association of America, a national association founded in 1980 that includes both researchers and clinicians with the added benefit of substantial numbers of sufferers from anxiety disorders and their family members.

One measure of this dramatic shift of focus in mental health is the emergence of many excellent books on anxiety written for both professionals and for people with the anxiety disorders, which are now recognized as the most prevalent of all of the groups of mental disorders. These two books are among the best of this bumper crop. Both reflect their authors’ distinguished clinical and research experience.

The Treatment of Anxiety Disorders, now in a substantially revised second edition, is focused on the cognitive behavior treatment of the six major anxiety disorders. The material is presented in a reader-friendly and highly systematic fashion. Each separate anxiety disorder is given four sections: a description of the syndrome itself and a description of the different treatments for the syndrome, followed by two practical guides, one for clinicians and the other for patients. The book is richly footnoted and firmly rooted in controlled research studies. This book focuses on the psychological treatments of the individual anxiety disorders, but it also contains an up-to-date discussion of the pharmacotherapy of each of the anxiety disorders.

An added bonus of this book is that the authors are from Australia, giving the contemporary understanding of anxiety disorders a useful international perspective. This location is particularly appropriate because the doyenne of the modern treatment of anxiety disorders, Claire Weekes, M.D., was a primary care physician from Sydney (1, 2).

The Anxiety Book, by contrast, is not footnoted, although it has an extensive set of endnotes for readers who are interested in finding references in specific areas. This book is less academic in tone and more easily accessible to people suffering from anxiety disorders. Like The Treatment of Anxiety Disorders, it contains many useful guides for both clinicians and patients. Rather than being organized around individual anxiety disorders, The Anxiety Book begins with an easy-to-understand description of "the faces of anxiety" before moving on to the common themes that link the anxiety syndromes. Having been introduced to the individual anxiety disorders, readers move on to the cognitive and behavioral solutions to the anxiety problem. This is followed by an extended discussion of "serenity skills" as well as "diet, exercise, and herbs." The heart of the book is its wonderful discussion of the medicines used to treat anxiety disorders.

One of the most controversial aspects of the treatment of the anxiety disorders is also the most common form of anxiety treatment: the use of the benzodiazepines such as alprazolam and clonazepam. In describing the treatment of generalized anxiety disorder, after noting that the benzodiazepines "can block the feelings of anxiety very effectively," The Treatment of Anxiety Disorders goes on to warn anxious patients about the many potential difficulties these medicines can cause:

They can interfere with thinking and your ability to remember new information. They can make you feel drowsy and sleepy. They can interfere with your natural sleep cycle and rhythms. They can produce tolerance, so you might need bigger and bigger doses for the same effect. They can produce withdrawal symptoms when you stop or cut down, producing unpleasant anxiety-like feelings. They can make it easier for you not to use the strategies taught in this program.

In clear contrast, here is how The Anxiety Book deals with the use of benzodiazepines in the treatment of generalized anxiety disorders: They are appropriate "when you require rapid relief from symptoms or when first-line antidepressants (especially the selective serotonin reuptake inhibitors) are ineffective or cause unacceptable side effects." One of the authors says,

I have found that long-term treatment [of generalized anxiety disorder with benzodiazepines], when administered to properly selected patients and carefully managed, is both safe and effective. I have patients who have taken Klonopin for years, and they remain in remission with few untoward side effects.

Both books are beautifully written, comprehensive, and sophisticated summaries of the best of modern research and clinical practice. They will be useful for everyone interested in the anxiety disorders.

Weekes C: Hope and Help for Your Nerves. New York, Signet (Penguin), 1991
Weekes C: Peace From Nervous Suffering. New York, Signet (Penguin), 1990


Weekes C: Hope and Help for Your Nerves. New York, Signet (Penguin), 1991
Weekes C: Peace From Nervous Suffering. New York, Signet (Penguin), 1990

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