the book aims to provide a comprehensive review of the treatment out-
come literature and a good grasp of the cognitive-behavioral treatment
methods with the most empirically demonstrated utility or promise for
each anxiety disorder. Although childhood and adolescent anxiety are dis-
cussed in places, the focus is on presentation and treatment of adult anxi-
ety disorders.

The book is divided into halves. The first half covers theoretical and em-
pirical developments relevant to fear, anxiety, and the anxiety disorders in
general. It begins with a general discussion of the concepts of fear, anticipa-
tory anxiety, and worry, relating them to various points along a threat im-
minence continuum. Some time is taken to support the notion of qualita-
tive differences among these states, due to the adaptive value of different
response profiles depending on the level of threat imminence. As alluded to
above, whereas worry is a state with little autonomic activation, and even
autonomic inflexibility, together with enhanced cognitive processing in
preparation for potential threats, anticipatory anxiety is represented by
shifts downward on the cognitive scale and upward on the autonomic scale
as a potential threat is detected. Finally, fear and panic are represented by
strong autonomic activation, limited cognitive processing, and strong be-
havioral urges and actions toward survival as threat becomes imminent. In
Chapter 2, these concepts are attached to anxiety disorders, which differ
primarily in the source of perceived threat and the various attendant seque-
lae. For example, social evaluation is the primary source of threat for so-
cial phobia, as are bodily sensations for panic disorder, and intrusive im-
ages or thoughts for obsessive compulsive disorder. Age, gender, and
cultural modulators of anxiety disorders are discussed, with particular em-
phasis on gender given the generally higher incidence of fear and anxiety
disorders among females.

Etiological pathways are presented in Chapter 3, and, as described
above, include nonspecific higher-order vulnerabilities in combination with
more specific second-order vulnerabilities that are dynamic and continu-
ally modulated by ongoing verbal transmission of information, vicarious
observation of others (modeling), and experience with fear or with painful
or aversive stimuli. Stressful life events are considered in light of evidence
for their contribution to the onset, exacerbation, and return of anxiety dis-
orders. Cognitive, behavioral, and physiological variables that contribute
to the maintenance of anxiety disorders are also described.

Cognitive-behavioral treatment methods and putative mechanisms un-
derlying such treatments are outlined in Chapter 4. Return of fear (i.e.,
partial or full return after its previous decline) is described in Chapter 5,
with special attention to recent developments in learning and memory that
offer explanations and ways of minimizing such return. Finally, Chapter 6
covers the integration of cognitive-behavioral and pharmacological ap-

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