Product reviews for Treating Stress and Anxiety

In over 15 years as a practicing psychotherapist, I have seen a lot of people with anxiety disorders or mood disorders and, given the high co-morbidity of the two illnesses (Kessler et al., 1994), a lot of people with both. As debilitating as depression can be, I have often thought that anxiety, at least in its more severe forms, is the harder emotion for people to subjectively bear. Anxiety is just so distressing to feel.

Therefore, I was not entirely surprised by findings of a recent longitudinal study (Sareen et al., 2005) that the presence of any anxiety disorder, with all other mental disorders controlled, is significantly associated with increased prevalence of suicidal ideation and attempts. Further, the presence of any anxiety disorder

in combination with a mood disorder is associated with a higher likelihood of suicide attempts when compared with mood disorder alone. Add to this the facts that anxiety disorders are the most common of the mental disorders, with an early age of onset (Kessler et al., 2005), and we have strong reasons for

clinicians to be well versed in effective methods for alleviating disorders of anxiety.

An excellent resource to this end is Treating Stress and Anxiety: A Practitioner's Guide to Evidence-Based Approaches by Lillian Nejad and Katerina Volny. The authors are clinicians in Australia who specialize in cognitive-behavioral techniques for the management of stress and anxiety. I have a large number of

books on my shelves on the topic of anxiety, but I would recommend this source to seasoned as well as new clinicians. The book is distinguished by its clear, accessible language, intuitive organization, and, best of all, client handouts that are among the best I have seen. The authors present information and techniques found mostly in cognitive-behavioral approaches, with a little mindfulness thrown in, that have been found effective in clinical trials. Readers wanting a detailed review of relevant studies, however, will not find it here. Rather, the aim of the writing is to be psycho-educational, practical, and straightforward enough that clients as well as therapists can grasp the concepts presented.

Chapters initially present an overview of stress and anxiety, discuss how to clarify presenting problems and set treatment goals, briefly describe treatments for specific anxiety disorders, and focus on fundamental lifestyle behaviors that promote resilience against the stresses of life. Active interventions for symptoms of anxiety disorders are addressed in chapters focused on breathing and relaxation exercises, challenging anxiety-promoting thoughts, and breaking avoidant behavior. Chapters on relapse prevention, co-morbid problems with depression, anger and substance abuse, and group programs for reducing

anxiety round out the book. Again, the concepts are not particularly new, but they are well presented, and much is covered in this relatively slim volume.

Useful specifics are included, such as the recommendation to practice relaxation exercises twice a day for one week and then once daily for four weeks. I find that clients with anxiety that they cannot control are comforted by instructions that are so well defined and laid out.

The authors capitalize on the truth that knowledge is power by including over 50 worksheets and handouts to give to clients. The handouts are up to date, such as the Harvard eating guidelines that were issued in 2007, and detailed when appropriate; the important subject of how to sleep well spans five well-organized

pages. Many of the subjects covered are pertinent to even clients without anxiety, such as dealing with stigma about mental health difficulties. All of the client material is angled toward promoting understanding and a sense of self efficacy; in my view, the handouts alone are worth the price of the book. A companion CD of client handouts is included for ease of reproduction, and recommended websites for therapists and clients are provided.

As we know, anxiety disorders involve not only the fear that something undesired may happen but also the fear that we cannot cope with those undesired possibilities of life or subjective experience. The latter fear often seems the more disruptive to the lives of our clients. The material in this book should go a long way to promoting a sense of being able to meet and manage the experience of anxiety and stress.

References
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry, 62, 593"602.
_ Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSMIII-R psychiatric disorders in the United States: Results from the National Comorbidity Study. Archives of General Psychiatry, 51, 8"19.



_ Sareen, J., Cox, B. J., Afifi, T. O., de Graaf, R., Asmundson, G. J., Have, M., & Stein, M. B. (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts: A population-based longitudinal study of adults. Archives of General Psychiatry, 62, 1249"1257.