| |
Basic InformationMore InformationLatest NewsQuestions and AnswersBlog EntriesBenzodiazepine Use Linked to Alzheimer's DiseaseObsessions and AddictionHow Exercise Can Reduce AnxietyFear of Heights – Story of a Rock ClimberAromatherapy and AnxietyBe Careful About What You Read OnlineMeditation and AnxietyStress and Anxiety: The Impact the Government Shutdown and The Fiscal Cliff Had on PeopleStress, Anxiety and Mindfulness MeditationWhat We Fear More Than DeathEmbrace Your PastYou Are So Much More Than FearA Simple Trick to Stopping Automatic Negative ThoughtsOf Anxiety and StressEye Movement Desensitization and Reprocessing (EMDR): Another Type of PsychotherapyHow to Ground Your Fear of FlyingThe Mental Squiggle: A Good Way to Gain Freedom from Mind TrapsTest Anxiety – When Your Mind Goes BlankYour 14:57 Minute RuleThe Helicopter Parent and the Dangers of Over ProtectingMeditation for Difficult EmotionsJust Breathe: A Practice to Calm the Anxious MindIt's Called Onychophagia or Nail BitingManaging Anxiety by Accepting your Brain's Alarm SystemDo We Need Anxiety? Thoughts for Entering the New YearDoes Anxiety Plus Depression Equal Depression Plus Anxiety? How Clinicians Really ThinkWhat are Thoughts and Who Are You?One Breath at a TimeCultivating Hope in the Eye of a StormIncreased Childhood and Adolescent Anxiety and Depression3 Steps to Silence the Inner-CriticA Way to Turn the Worry Volume DownPractice a Self-Care DietBrain: Chronic Alcohol Maintains FearWhat You Need to Know About Generation XhaustedStrangers and The Need For Personal SpaceRecognize How Precious Your Life IsTaming Anxiety's Effect on MemoryBuried Alive: Saving, Collecting and HoardingStress on the Rise? Two Simple Practices to Find ReliefKids are More Stressed than We Realize: 4 Steps to TakeWhy You Just Can't Stop Texting and DrivingGetting Unstuck: One Practice that Can HelpThe Transitional Objects and Self ComfortBeing Kind to Your Body is Healing to the MindStress Reduction, Tropical Fish and AquariumsAre You Superstitious?Dental PhobiaWhen Calmness is a Trigger for Fear and How to Change itWhy You Need to Get in Your Body Now5 Steps to Change Feelings of Anxiety Of Anxiety and Depression and PlayThe Importance of Saying "No"OCD and ReassuranceA Tip for Happiness: Turn Routine into WonderTaking Back Control of Your Mind: The Power of AcceptanceAvoidance in OCD: It's Never the AnswerResidential Programs for OCD: How Long Should You Stay?Angst in the Face of Economic Meltdown: Managing Your Anxiety When The Stress Won't Go Away! Part IIAngst in the Face of Economic Meltdown: Managing Your Anxiety When The Stress Won't Go Away! Part IWould You Want to Do Therapy Online?8 Ways to Overcome Homework AnxietySensory Overload, Tension and Stress Keep Calm and Carry On: Potential PitfallsCognitive Consistency and Cognitive DissonanceBe in the Eye of the Storm Understanding Recovery Avoidance in OCDBreaking Free from LimboCBT and Mindfulness for Social Anxiety: Train your Brain for Social SuccessHow to Work with UncertaintyNational Debt, Stress and Perception, Is It Really That Bad?Helping or Enabling...A Fine Line When Dealing with OCDGot IBS? Study Says to Try a Little MindfulnessIs Mindfulness Uniquely Buddhist? Decision Making, Who Is In Control?Can you Improve Life Satisfaction by Changing Your Focus?ERP Therapy - A Good Choice for Treating Obsessive Compulsive Disorder (OCD)Clear Away the Mental ClutterDepression & Panic Disorders: Jennifer’s StoryUnchecked Journalism Can Lead to Mindful MisperceptionsI Wish I Had an Illness...Mental or PhysicalDo You Know How Overgeneral Memory Can Impact Depression?Did You Know You May be Keeping Difficulty Around?Negative Self-Talk: A Culprit of Anxiety and DepressionOnline Mindfulness-Based Anxiety TherapyHow to Stop Panic Attacks and Panic AnxietyPanic Attacks: The 30-Minute RuleThe Childhood Anxiety Epidemic: What Parents Can Do About It Help for Panic Attacks & Panic AnxietyHow to Mindfully Work with Difficult EmotionsOvercoming Social Anxiety with Mindfulness TherapyThe Guilts: A Psychoanalytic and Cognitive ViewWhy We Fear Success and What to DoPTSD, Veterans and Equine TherapyAgoraphobia and Spatial Orientation: An Interesting AngleElisha Goldstein's Top 10 MentalHelp Blogs of 2010Online Mindfulness Therapy for AnxietyNewly Married Couples and Sexual FrequencyAn Interview with Joseph LeDoux, Ph.D., on the Synaptic Self and Memory ReconsolidationAnxiety TherapyAlthough We are Wired to Feel Stuck: There is Hope Let's Learn: Trichotillomania (Part 2)An Interview with Monica Ramirez Basco, Ph.D., on ProcrastinationLet's Learn: Trichotillomania (Part 1)What Does the Tetris Effect Have to Do With You? How to Flood Your Life With ConfidenceFascinating Explanations: KindlingWhat to Do in the Places that Scare You: Pema ChodronSelf Therapy: An Interview with Jay Earley, PhDReflections On A SeasonMake Your Life as Inconvenient as PossibleSelf CompassionPerceptions of Life TodayNew Study: 5 Million Californians Need Mental HelpPrepare Now: How to Get Teens to Focus with Homework You May be Trapped in Your Own MindYour Subconscious Mind May be Making Critical Errors in JudgmentOverweight? Your Brain May not Know When to StopOur Anxiety Disorders Topic Center has been Updated!Shyness and Marital ProblemsPeace not War What Everyone Should Know about the Dangers of Their MindsHow Well Do You Know the Committee in Your Mind?More Mindfulness Research for Anxiety and Depression: Here's the RubHow to Slow Down Your Racing Heartbeat When Feeling AnxiousYour Worry or Your Life? The Dark Side of Happy Anniversary Taking a Mindful Path Through ShynessYou vs. Procrastination: 1 (Mindful) Secret to Winning the BattleFreedom from Your Anxious MindAre You Wired to Worry? 3 Common Mistakes People Make When Working with InsomniaThere is No Such Thing as ADDWhat You Need to Know to Help Heal Insomnia Overcoming School Anxiety: An Interview with Diane Peters MayerAn Interview with Gail Steketee, PhD, on Hoarding and OCD (Obsessive-Compulsive Disorder)In a Falling Economy, Trust Your Gut Or Reason? Avoidant Personality Disorder and Social PhobiaWhat Every Parent Should Know About School Anxiety5 Steps to Emotional Freedom: Placebo or Panacea?Can Anxiety Be a Good Thing? I Blush, Therefore I...Feeling Stuck with Anxiety or Depression? Try this Today! Catastrophizing Controlling Your Life: 3 Steps to Break FreeNew A&E Series Explores Anxiety DisordersRejection, Why Does It Hurt So Much?An Interview with Steven Phillipson, Ph.D. on the Nature and Treatment of Obsessive Compulsive Disorder (OCD)Anxiety, Stress and Depresion in Light of the RecessionTherapy for Borderline Personality Disorder – building a life instead of digging up the past?Young Yet Sad: The Social PhobicHow trying to avoid your fear, anxiety, and panic keeps it knocking on your doorCatastrophizing Illness: Mind and Body RevisitedAn Interview with Victoria Lemle Beckner, Ph.D. on Treatments for Post-Traumatic Stress Disorder (PTSD)Social Phobia and Self Concept and the BrainAn Interview with Frank Ochberg, MD on Post-Traumatic Stress Disorder (PTSD)TIME OUT! 2 Things you can practice today to stave off anxiety and depression in this hectic time. Shy Bladder Syndrome (Paruresis): Getting HelpAn Interview with Edna Foa, Ph.D. on the Nature and Treatment of Post-traumatic Stress Disorder (PTSD)Going to the Dentist: Fears and PhobiasStuff, Why Is It So Difficult to Part With?An Interview with Michelle Craske, Ph.D. on Anxiety Disorders Research and TreatmentBlenophobia, The Fear of NeedlesAnxiety and Alcoholism and StigmaDo You Have a Shy Bladder?Obsessive Compulsive Disorder, Plagued by DoubtPost Traumatic Stress Disorder and Iraqi VeteransPsychotherapy and Murder in New York: Should We All Stay Home?An Interview with David H. Barlow Ph.D. on the Nature and Treatment of Anxiety and Panic DisordersWorried SickAn Interview with Richard Heimberg, Ph.D. on Generalized Anxiety Disorder and Social Anxiety Disorder Research and TreatmentTreating PTSD, Part TwoNational Stress Øut WeekHalloween...Fear With A PurposeCollege and Mental Health Problems, They Go TogetherSeparation Anxiety DisorderRecognizing emotion gets harder or easier depending on your moodThe Story of A Psychiatric Service Dog TeamEarly verbal abuse results in more adult depressionOn Being A PerfectionistChronic cortisol exposure causes mood disordersTreating PTSD with Beta-BlockersDavid Beckham has OCDCortisol May Be an Anxiety TreatmentGenetic contribution to OCD may have been identified VideosLinksBook ReviewsSelf-Help Groups |
| | |
by Dan J. Stein and Eric Hollander (editors) American Psychiatric Publishing, 2002 Review by Peter B. Raabe, Ph.D. on Aug 12th 2002 
As its title suggests, this is a
large format publication, and a huge book, which its publisherAmerican
Psychiatric Publishingclearly intends to be used as an academic course
text. It contains 37 essay chapters
written either individually or collaboratively by theoreticians and
practitioners in the field of psychotherapy.
They discuss in clinical language the phenomenology and theoretical
models of anxiety disorders as well as their treatment by means of
psychotherapy and medication. The book
is subdivided into ten parts: the first
part deals with the history and various conceptions of anxiety disorders; part
two and three cover generalized anxiety disorders and mixed anxiety-depressive
disorders. From the fourth part onward
the topics are more specific, covering issues such as obsessive-compulsive
disorders, panic disorders and agoraphobia, social phobia, specific phobia,
posttraumatic and acute stress disorder, and anxiety disorders in certain
populations such as children, the elderly, and substance abusers. The final part takes a step back from the
discussion of the disorders themselves and considers the cultural and social
aspects of anxiety disorders including the economic costs of both the
consequences of their occurrence in a population and the actual cost of
treating them. It ends with a short
appendix of Internet resources and a satisfyingly substantial index.
While this book contains
informative reports on various problems that can arise in the human condition,
such as the lingering distress after experiencing a traumatic event and the
fear of certain situations, theres an unsettling and sustained equivocation in
the overall conception of anxiety. Its
discussed at times as a physical problem and at other times as a problem in
logic and reasoning. Theres a constant
switching back and forth between talk of anxiety as a medical disease (caused by inferior genetics, faulty
neurochemistry, or malfunctioning brain circuitry) and anxiety as experienced
for a reason (worry or stress associated with problems in everyday life). In one chapter the authors claim, The
medial prefrontal cortex also plays a prominent role in anxiety (p. 54), while in the next chapter the
author states, Environmental stresses play a central role in the expression of
anxiety and in the precipitation of episodes of mental illness (p. 60). The tension between these two
models remains unresolved throughout.
Every section of the book offers
both a chapter on neurobiology and pharmacotherapy as well as a chapter on
psychology and psychotherapy. Its as
though the writers as a group are of two minds. For example, the section on Generalized Anxiety Disorder first
presents a chapter which maintains that there are a number of pharmacological
agents that can be used to treat the biomedical disease of anxiety (albeit with some serious side effects),
followed by a chapter which explains the effectiveness of cognitive/discursive
therapy in treating anxiety with no mention of drugs. It makes me wonder, since
this equivocation throughout the entire book has caused anxiety in me does it
mean Im now suffering from a biomedical disease?
One of the passages that most
clearly illustrates why this book makes me uneasy is located in chapter 31,
which deals with cultural aspects of anxiety disorders. The two authors argue that cross-cultural
instances of panic attacks are evidence that they could be a biomedical disease
involving a false suffocation alarm.
As an example they cite the case of the Inuit who has a fear of
kayaking (p. 465). The authors claim that this case is
equivalent to western cases of fear of driving, and argue that because these
similar fears occur in various cultures it may therefor be concluded that they
are in fact the same biomedical disease.
Now I imagine that most people would assume that an Inuits fear of
kayaking is probably related to an earlier life-threatening experience
involving water or kayaking and what the Inuit imagines might happen if he goes
near the water again. A fear of driving
may have similar experiential reasons behind it, but the authors suggest that
the similarity between the Inuits fear of kayaking and the fear of driving is
evidence of a biomedical disease. They conclude,
a range of evidence indicates that panic disorder is a universal biomedical
disorder and that this diagnosis does not represent a category fallacy because specific neuroanatomical circuits and
neurochemical systems underpin the symptoms of panic disorder" (p.
466). But dont specific
neuroanatomical circuits and neurochemical systems underpin every human
emotion? Theres something very odd
about an argument that says, because an emotion involves neuroanatomical
circuits and neurochemical systems it must therefor be a biomedical
disease.
While theres a lot said about the
effects of various drugs in the ostensibly successful treatment of anxiety
disorders, theres no mention of what actually constitutes treatment
success. Its simply taken for granted
that medications are good because they eliminate undesirable things such as
excessive worry. But the question is
how? If a pill inhibits a patients
customary thoughts and emotions by suppressing them with a drug-induced stupor,
should this drug-induced stupor then count as a treatment success? If a drug reduces worry but forces the
patient to suffer instead from a number of physical side effects is this a
treatment success? In fact Im puzzled
as to why the editors of this textbook would expend so many pages promoting
medication in the first place when the evidence from clinical research, cited
throughout this volume itself (e.g.,
86, 99, 144, 275, etc.), has repeatedly and convincingly shown that talk
therapy produces significantly better long-term results than drug therapy, and
without the debilitating side effects.
Furthermore, theres a strange sort
of selective perspective in many of the chapters. For example, in the third chapter the authors refer to medical
experiments conducted on rats and rhesus monkeys, and the effectiveness of
tricyclic antidepressants and selective seratonin reuptake inhibitors in
sedating these animals that have been specifically raised to be
anxiety-ridden (p. 37). But they fail to mention the fact that,
unlike rats and monkeys, its possible to substantially reduce the anxiety of a
rational human being by helping him or her, in a calm and empathetic manner, to
think things through without the use of drugs.
I suppose the authors felt there was no need to mention empathetic human
discussions in a chapter on the effects of anti-anxiety drugs on rats and
monkeys, but by focusing exclusively on medications it gives the impression
that empirical research favors the medical model, which is clearly not the
case. In fact studies have found that the
most recent wonder drug, Ritalin
(given to children diagnosed with problematic attention spans), has the
same harmful long-term effects on the brains of laboratory rats as amphetamines
and cocaine.
This is a well-organized academic
textbook written in highly technical language.
I believe educators and students in clinical psychology and psychiatry
will find it similar to other contemporary academic texts in the field. It strongly advocates the medical model of
mental illness found in the latest edition of the DSM, it vigorously promotes
the use of psychopharmaceuticals, and it offers typically ambiguous messages
concerning the cause, nature, and treatment of non-physical distress. But I see it as only of limited interest to
psychotherapists who dont have a license to prescribe medications, counselors
who dont subscribe to the medical model, and mental health services consumers
who are not proficient in psychotherapeutic and psychopharmacological
phraseology.
© 2002 Peter B. Raabe
Peter B. Raabe
teaches philosophy and has a private practice in philosophical counseling in
North Vancouver, Canada. He is the author of the books Philosophical
Counseling: Theory and Practice (Praeger, 2001) and Issues
in Philosophical Counseling (Praeger, 2002). |