Anxiety

By Genest, Myles | Canadian Psychology, August 2000 | Go to article overview

Anxiety


Genest, Myles, Canadian Psychology


S. RACHMAN East Sussex: Psychology Press Ltd., 1998, x + 179 pp. (ISBN 0-86377-802-X, Cdn.$48.25, Softcover) Reviewed by MYLES GENEST In the last decade or two, the pre-eminence of mood disorders in research seems to have been displaced by anxiety disorders. In part, this has been fueled by DSMIv's clustering of agoraphobia, panic disorder, specific phobia, social phobia, obsessive-compulsive disorder, post-traumatic stress disorder, acute stress disorder and generalized anxiety disorder (as well as anxiety related to medical conditions and substance use) into the .anxiety disorder" category. Although there are obvious shortcomings in the categorical classification system, by underlining the interrelationships among these categories, DSM helped draw research attention to the nature of anxiety and its predominance among a group of psychological problems. Whereas psychoanalytic theory held that anxiety underlay all psychoneuroses, contemporary views of anxiety have discriminated among what were formerly linked together as "neuroses," and, in doing so, have spurred work on anxiety itself.

Anxiety has also increasingly gained attention in the popular press. Violent incidents such as the massacre of December 6, 1989 at the Ecole Polytechnique in Montreal, and multiple-murders in schools, combined with the aftermath of natural disasters, airplane crashes and armed conflict, have all increased the public's awareness that trauma have consequences, and that one of these consequences is ongoing, disruptive anxiety. Another motivator of interest in anxiety has been the perception that expectations of both workplace and family are continuously rising, so that "stress" has enjoyed several decades of attention as the principal modern malady. When I opened a recent Weekend Post newspaper, alongside such Cosmo-inspired quizzes as "Are You In a Sexual Slump?" was an "Anxiety Inventory," with five-point scaling of such items as "I worry about things that aren't worthwhile," "I feel tense," and "I sweat more than other people." This should be no surprise, since, as Lader (1994) has noted, up to 15 percent of general practitioners' patients are seeking help for some form of anxiety.

Several strong summaries of research and clinical work in anxiety have been produced, including Barlow's Anxiety and its disorders (1988), Heimberg, Leibowitz, Hope and Schneier's Social phobia: Diagnosis, assessment, and treatment (1995), and McNally's Panic disorder (1994). These are major works, each summarizing existing knowledge and putting its own stamp on the area, theoretically and clinically. At 155 pages, plus references, Stanley Rachman's Anxiety takes a surprisingly strong place among this literature. Rachman's summary of theory, research, and practice related to anxiety is a prize. He has managed a succinct presentation of the major problems and issues, recounted what is known, and challenged the reader with the unsolved riddles.

Anxiety is one book in the series Clinical psychology: A modular course published by Psychology Press and edited by Chris R. Brewin. Rachman's and other books in the series are not meant to stand beside works, which, like Barlow's volume, are aimed at specialists. Rather, these "modules" are intended to provide resources on particular topics for professionals and students, as well as to form a collective substitute for a clinical psychology text. Anxiety includes chapters on the nature of anxiety, influences on anxiety, and theoretical views of anxiety, highlighting the importance of conditioning and neoconditioning theory, before turning to separate chapters on each of panic, agoraphobia, obsessions and compulsions, social anxiety, and generalized anxiety disorder.

One of the strengths of Rachman's contribution is the overview chapters, concerned with the concept of anxiety and competing theoretical views of its nature. The current picture of anxiety is placed in a clear historical context, indicating, for example, the significance of Mowrer's two-stage theory in the development of an understanding of anxiety and fear and in the stimulation of research in the area. …

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