August 2009  << Back  

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 BOOK REVIEWS

The Anti-Anxiety Workbook. Proven Strategies to Overcome Worry, Phobias, Panic, and Obsessions

Richard Balon, MD

Wayne State University, Detroit, MI, USA

Anxiety disorders are fairly common, and their treatments are far from ideal. Various therapies, namely cognitive-behavioral therapy (CBT) and/or medications, have been the mainstay treatment of anxiety disorders and symptoms. However, the patient’s participation in the treatment process is emerging as an important factor in treatment. Patient participation could include discussing the medication and adhering to it or being an active participant in therapy by, for example completing homework assigned during CBT. Patients also could participate by learning about the nature of the anxiety disorder and available treatments and practicing self-help strategies. These strategies are the subject of numerous self-help books for patients and their families including the latest one, Antony and Norton’s The Anti-Anxiety Workbook.

(Part of The Guilford Self-Help Workbook Series). By Martin M. Antony and Peter J. Norton; The Guilford Press; New York, New York; 2009; ISBN 978-1-59385-993-0; pp 261; $19.95 (paperback).

The book consists of an Introduction called “The faces of anxiety”; 3 main parts, Part I: “The prep,” Part II: “The program,” and Part III: “In the long run”; and an Appendix.

The first part contains 3 chapters. Chapter 1, “Anxiety: the big picture,” defines anxiety and fear, their relationship, their benefits, and their triggers (external and internal triggers), and reminds the reader that everybody experiences anxiety and/ or fear from time to time. The text continues with descriptions of major and not so major anxiety disorders, including separation anxiety, hypochondriasis, fear of death, and test anxiety. The authors note that often it is difficult to figure out which anxiety disorder a patient has and people’s problems don’t always fit into neat categories (p 25). The chapter continues with a discussion of causes of anxiety disorders and closes with a brief overview of effective treatments. Chapter 2, “Getting to know your anxiety,” guides the reader through a self-assessment of anxiety—the first critical step in treatment. The text discusses situations and objects that trigger fear, variables that affect fear, physical sensations associated with anxiety and fear, anxiety-provoking thoughts and beliefs, ways to avoid external triggers, safety behaviors to steer clear of danger, how to avoid certain internal experiences, and associated problems such as depression or relationship conflicts. The chapter includes tables summarizing common situational triggers and typical anxiety-provoking thoughts, tables for the reader to record his/ her triggers, variables, physical sensations accompanying anxiety, situations to avoid, and safety behaviors, and a table called “Weekly record of anxiety” to document overall anxiety, its severity, and progress. The last chapter of the first part, “Getting ready for treatment,” focuses on issues to consider when determining the best time to start treatment, such as the problem’s severity, potential costs and benefits to the patient, and possible obstacles and challenges (p 58). The discussion of obstacles is very informative. The chapter also focuses on setting short- and long-term goals for treatment, ways to include family in the treatment process, and how to decide whether to seek professional help—ie, choosing a professional, treatment strategies, and developing a comprehensive treatment plan. The authors remind the reader that, “if you generally prefer to work collaboratively, then working with a therapist may be a good option, in addition to using this book” (p 70).

The 7 chapters of the second part of the book guide the reader through the treatment process. The titles of these chapters describe the content well: “Changing your anxiety thinking”; “Eliminating the safety net”; “Confronting feared objects and situations”; “Confronting scary thoughts, memories, images, and urges”; “Confronting frightening feelings and sensations”; “Learning to relax: relaxation, meditation, and acceptance”; and “Medications and herbal remedies.”

The chapter on changing anxiety thinking provides a useful discussion of types of anxiety thinking, such as probability overestimation, catastrophizing, rigid rules, anxiety-provoking assumptions, negative core beliefs, anxiety-provoking impulses and imagery, and strategies for changing anxious thinking. The chapter on eliminating the safety net emphasizes that “exposure will probably be the most important strategy for your recovery. Unfortunately, it can also be the most difficult strategy because it requires you to do exactly what your mind has been telling you not to do. And it only works if you give 100%” (p 107). The chapter also includes one’s “own exposure plan” (p 111 and following pages).

The chapter on confronting feared objects and situations includes an informative and understandable table discussing these objects and situations. Similarly, the chapter on confronting frightening feelings contains a useful table on common interoceptive exercises. The chapter on learning to relax points out that “relaxation-based strategies are often used along with the other techniques…including thought challenging and exposure” (p 157). As part of this chapter, there are 2 scripts for progressive muscle relaxation, a long and a short one. This chapter also discusses breathing retraining and mindfulness- and acceptance-based strategies. The last chapter deals with medications and herbal remedies. Although the authors try to give these approaches justice, the lack of a physician-author or possible author prejudice makes some of this chapter a bit biased. The authors do not discuss randomized controlled trials in their examination of therapies. Side effects are overemphasized at times—eg, stating that common side effects of benzodiazepines include depression, headache, insomnia, and nervousness—and doses are not always what an experienced physician would use—I would start an anxious patient on 10 mg/d of imipramine, not 25 mg/d; I would try to go higher than 30 mg/d of buspirone.

The last part of the book focuses on the long course of anxiety and its treatment and how to “cement changes obtained during the work” (p 3) in chapters such as “Creating an anti-anxiety lifestyle”; “Overcoming treatment obstacles”; “Living without anxiety”; and “A guide for family and friends.” The “Creating an anti-anxiety lifestyle” chapter focuses on diet and nutrition (weight loss), social life, physical exercise, sleep, and avoiding caffeine, nicotine, alcohol, and other drugs. The chapter on overcoming obstacles is important and should be used—as the authors advise—through the entire treatment process. It discusses obstacles such as finding time for treatment, coping with other psychological problems such as depression or substance abuse, getting motivated, life stress, medical illness, and a lack of relevant skills, such as communication skills.

The Appendix contains several helpful resources, such as a list of associations based in the United States and elsewhere, Internet resources, and recommended readings and videos.

As the authors state, this book is “written for people who experience anxiety and fear…and here you’ll learn the most widely studied and accepted techniques mental health professionals use for helping people overcome problems of extreme anxiety…the book is carefully designed to help readers develop a treatment plan designed specifically for them.” The book will be of great use to all patients with anxiety disorders. It is informative, written in a highly readable style, and contains a lot of useful and practical strategies, including many tables/diaries for patients’ use. I believe that a clinician treating patients with anxiety disorders, regardless of role, could/should recommend this book to his or her patients. It would be a great complement to treatment that will help patients understand and handle anxiety. The small amount of possible antipsychiatry bias did not spoil the book for me. The book is definitely worth buying and recommending to all of your anxious patients.