The Treatment of Anxiety Disorders: Clinician’s Guide and Patient Treatment Manuals
Gavin Andrews, Rocco Crino, Caroline Hunt, Lisa Lampe, Andrew Page, 423 pp, ISBN 0-521-46927-9, Cambridge University Press 1996
Writing for psychiatrists and clinical psychologists, Gavin Andrews and his co-authors claim that their book ‘provides most of the information needed for the successful treatment of patients with anxiety disorders’. About three-quarters of the book is said to be unique in terms of format, consisting of ‘patient treatment manuals’ (PTMs) and accompanying ‘clinician’s guides’ (CGs) dealing with each of the five common primary anxiety disorders (panic disorder and agoraphobia; social phobia; specific phobias; obsessive-compulsive disorder; generalised anxiety disorder). Secondary anxiety disorders (for example, post-traumatic stress disorder) are not included.
The PTMs are self-help manuals and the purchaser of the book is at liberty to copy them for individual patients, who will use them as self-help manuals. They are ‘both the guidebook and the journey’; whereas the CGs, ‘for clinicians’ eyes only’, are about the art of therapy, containing advice about devising treatment programmes and critical issues in therapy. The rest of the book consists of an introductory section dealing with general issues in anxiety disorders and their treatment, and detailed contemporary (references up to and including 1993) reviews of the epidemiology, aetiology and evaluation of each disorder. The contents are grouped by disorder with four chapters on each — syndrome, treatment, PTM and CG. The PTMs are printed in single-column format, whereas the rest of the book, for clinician use, is printed in double columns. An initial chapter helpfully entitled ‘Read Me’ describes the layout and authors’ intentions.
The book’s claim to fame rests with the PTMs and CGs, which are designed to bridge the gap between knowing about something and knowing how to do it. ‘It’ is cognitive behaviour therapy, the treatment of choice in the anxiety disorders. Alas, there are no quick and easy solutions that can be applied in busy out-patient clinics or doctors’ surgeries. There is no avoiding up to 20 h of therapist-patient contact, preferably over a smaller number of weeks. The PTMs seem straightforward to use. The contents typically cover an introductory explanation, physical relaxation techniques, cognitive aspects, dealing with avoidance behaviours, problem solving, maintaining progress and recommended reading. There are a lot of words, which I suspect would deter many of my patients.
Is the book genuinely new, as claimed? The contents seem to me, a general adult psychiatrist, uncontroversial. The writing is clear and the information is easily accessible. The book is a useful source of information for teaching both clinical medical students and psychiatrists in training. Colleagues with an interest in the psychopharmacology of anxiety disorders have pronounced in its favour, although ‘one commented on the verbosity of the PTMs. What is new is the combination of theory and practice, so that a single volume can serve as introduction, reference, treatment manual and problem-solving guide for clinicians ‘at all levels of expertise’. However, in the UK, the various components will probably be accessed by different disciplines. NHS psychiatrists generally will not have the time to use the book as a treatment manual. Junior doctors would probably be able to use the PTMs and CGs as a (desirable) training experience, but the issue of supervision arises. The likeliest users in therapy would be clinical psychologists and nurse behaviour therapists: how this book compares with previous offerings I cannot say. It goes beyond the available self-help literature.
In my opinion this book deserves a place in any medical library for its clear and comprehensive theoretical overview, and its synthesis of theory and practice for all doctors whose work brings them into contact with anxious patients. Because of the constraints of working practices, few doctors will be able to use it to its full potential.