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Handbook of anxiety disorders
BOOK REVIEW Handbook
Edited
by CYNTHIA Pergamon
of Anxiety
Disorders
G. LAST and MICHEL Press. New York.
This book contains something about anxiety disorders for everyone who is interested in the field. With 37 chapters. the edited volume begins appropriately with The Neurophysiological Basis of Anxiety. This excellent chapter updates Papez’s 1937 observations about the importance of the limbic system in emotions. A theory of septohippocampal function is related to the fight/fltght systems involved with anxiety. The author states. “A theory is offered of the psychological and informational processing functions discharged by the behavioral inhibition and fight/flight systems and of the particular neuronal pathways applied to the symptoms and syndromes of anxiety as well as to personality characteristics that predispose an individual to anxiety”. Part II consists of six chapters which describe the anxiety disorders as listed in DSM-III-R. A chapter on PostTraumatic Stress Disorder does not mention or discuss three recent books or the cognitive and behavioral literature on the subject. Part 11 concludes with a chapter contrasting anxiety and depression. Part III starts with a good chapter on genetics and IS followed by chapters on animal and pharmacologic models for anxiety. The chapter on psychophysiology discusses the three main response components of anxiety: physiological. psychological. and behavioral in terms of cardiovascular. respiratory. and electrodermal activity. Part III closes with chapters on psychodynamtcs. stress and vulnerability, life events. and personality disorders. Part IV. Psycholopcal Treatmettts. covers the therapeutic spectrum from psychotherapy to an admirable chapter on hypnosis. The chapter on behavior therapy IS especially good and includes all of the anxtety disorders listed in DSM-III-R. The chapter on cognitive approaches describes a model of anxiety and a descriptton of treatment. The authors conclude that cognitive therapy. especially in non-phobic disorders. is promising; however. initial evaluation of the effectiveness of this approach must await the publication of large-scale. well-conducted controlled trials. The chapter. Murital and Family Therap!. stresses the importance of the spouse and other family members in a comprehensive treatment program for anxiety disorders. Part V. Phurmnco/ogic Treatmertt. reviews the literature on the benzodiazepines. beta-adrenerglc blqckers. tricyclic antidepressants. and monoamine oxidase tnhihttors in the treatment of panic and other anxiety dIsordera. While the evidence is strong for the utihzation of henzodiazepmes, TCA’s. and MAOI’s in blocking panic attacks. the use of the beta blockers for either panic or anxiety is unclear. The
HERSEN
1988
chapter, Comhirted Pharmacologic attd P.s~ci~ologtcul Treatment, examines the literature on this topic. More than any other issue. the use of drugs vs. psychotherapy or behavior therapy divides clinicians, usually on the basis of whether they can or cannot prescribe medication. As the evidence for the utilization of medication mounts. espccially in the treatment of panic disorder. with or WIthout agoraphobia. and obsessive compulsive disorder. pharmacologic interventions will assume more importance. Medicaiion, however. does not work tn a vacuum. and behavior therapy and psychotherapy when added to pharmacotherapy seems superior in panic and agoraphobia. In the minds of many. however. this issue has not been settled. as each camp strives for superiority over the other. in Part VI. Special Topics. covers anxiety disorders children. adolescents. and the elderly. suicide and anxiety. medical illnesses and anxiety. and primary preventton. Although the chapter on prevention IS placed at the end of the book. this does not diminish its importance. The development of coping skills and a good social support system generally are assumed to be important in prcventing anxiety disorders. The comments of Duzehbury and Albee on prevention are excellent. They emphasize the need for prevention. at least on a par with treatment. and “Unless we are prepared to walk an endless conclude. treadmill. WC must reorder our priorities”. The Handhook ends with an excellent chapter by David Barlow titled. Furwe Dtrectrotls. This volume is a comprehensive presentation of the various points of view involved in the cause. classiftcation. treatment. and prevention of the anxiety disorders. The most disappointing feature of the book is the scant subject index (Icss than three pages). A volume about anxiety disorders compiled hy clinicians and researchers from various disciplines. orientations. and therapeutic potnts of view needs cross-references. especiallv for the student not familiar with current literature. As in all edited books. thcrc is overlap, conflicting ideas. a few shallow chapters. hut overall. the Handbook is excellent. The editors arc to he commended. and I would recommend this hook to my colleagues and to students of anxlcty disorders. C. B. SCRlGNAR The Rehuvior Therapy Center .?6.?5 Getterul Pershiq Street New Orlctms, LA 70115. U.S.A.
Edited
by CYNTHIA Pergamon
of Anxiety
Disorders
G. LAST and MICHEL Press. New York.
This book contains something about anxiety disorders for everyone who is interested in the field. With 37 chapters. the edited volume begins appropriately with The Neurophysiological Basis of Anxiety. This excellent chapter updates Papez’s 1937 observations about the importance of the limbic system in emotions. A theory of septohippocampal function is related to the fight/fltght systems involved with anxiety. The author states. “A theory is offered of the psychological and informational processing functions discharged by the behavioral inhibition and fight/flight systems and of the particular neuronal pathways applied to the symptoms and syndromes of anxiety as well as to personality characteristics that predispose an individual to anxiety”. Part II consists of six chapters which describe the anxiety disorders as listed in DSM-III-R. A chapter on PostTraumatic Stress Disorder does not mention or discuss three recent books or the cognitive and behavioral literature on the subject. Part 11 concludes with a chapter contrasting anxiety and depression. Part III starts with a good chapter on genetics and IS followed by chapters on animal and pharmacologic models for anxiety. The chapter on psychophysiology discusses the three main response components of anxiety: physiological. psychological. and behavioral in terms of cardiovascular. respiratory. and electrodermal activity. Part III closes with chapters on psychodynamtcs. stress and vulnerability, life events. and personality disorders. Part IV. Psycholopcal Treatmettts. covers the therapeutic spectrum from psychotherapy to an admirable chapter on hypnosis. The chapter on behavior therapy IS especially good and includes all of the anxtety disorders listed in DSM-III-R. The chapter on cognitive approaches describes a model of anxiety and a descriptton of treatment. The authors conclude that cognitive therapy. especially in non-phobic disorders. is promising; however. initial evaluation of the effectiveness of this approach must await the publication of large-scale. well-conducted controlled trials. The chapter. Murital and Family Therap!. stresses the importance of the spouse and other family members in a comprehensive treatment program for anxiety disorders. Part V. Phurmnco/ogic Treatmertt. reviews the literature on the benzodiazepines. beta-adrenerglc blqckers. tricyclic antidepressants. and monoamine oxidase tnhihttors in the treatment of panic and other anxiety dIsordera. While the evidence is strong for the utihzation of henzodiazepmes, TCA’s. and MAOI’s in blocking panic attacks. the use of the beta blockers for either panic or anxiety is unclear. The
HERSEN
1988
chapter, Comhirted Pharmacologic attd P.s~ci~ologtcul Treatment, examines the literature on this topic. More than any other issue. the use of drugs vs. psychotherapy or behavior therapy divides clinicians, usually on the basis of whether they can or cannot prescribe medication. As the evidence for the utilization of medication mounts. espccially in the treatment of panic disorder. with or WIthout agoraphobia. and obsessive compulsive disorder. pharmacologic interventions will assume more importance. Medicaiion, however. does not work tn a vacuum. and behavior therapy and psychotherapy when added to pharmacotherapy seems superior in panic and agoraphobia. In the minds of many. however. this issue has not been settled. as each camp strives for superiority over the other. in Part VI. Special Topics. covers anxiety disorders children. adolescents. and the elderly. suicide and anxiety. medical illnesses and anxiety. and primary preventton. Although the chapter on prevention IS placed at the end of the book. this does not diminish its importance. The development of coping skills and a good social support system generally are assumed to be important in prcventing anxiety disorders. The comments of Duzehbury and Albee on prevention are excellent. They emphasize the need for prevention. at least on a par with treatment. and “Unless we are prepared to walk an endless conclude. treadmill. WC must reorder our priorities”. The Handhook ends with an excellent chapter by David Barlow titled. Furwe Dtrectrotls. This volume is a comprehensive presentation of the various points of view involved in the cause. classiftcation. treatment. and prevention of the anxiety disorders. The most disappointing feature of the book is the scant subject index (Icss than three pages). A volume about anxiety disorders compiled hy clinicians and researchers from various disciplines. orientations. and therapeutic potnts of view needs cross-references. especiallv for the student not familiar with current literature. As in all edited books. thcrc is overlap, conflicting ideas. a few shallow chapters. hut overall. the Handbook is excellent. The editors arc to he commended. and I would recommend this hook to my colleagues and to students of anxlcty disorders. C. B. SCRlGNAR The Rehuvior Therapy Center .?6.?5 Getterul Pershiq Street New Orlctms, LA 70115. U.S.A.