How to use this unusual book

This book is about the treatment of anxiety disorders, about helping people with chronic anxiety disorders to become well and stay well. It contains discussions of the nature and treatment of each syndrome, it describes the problems commonly encountered during treatment, and it outlines some management strategies. Of greatest value, it contains Patient Treatment Manuals for the common anxiety disorders.

Anxiety disorders are not simply about being too anxious, they are about irrational worry and avoidance of situations that are the focus of this worry. Persons with panic disorder worry that their panic will result in physical or mental collapse;those with social phobia worry that their behavior will result in shame; and those with specific phobias fear personal harm. Those with obsessive–compulsive disorder (OCD) worry that their obsessions will come true; those with posttraumatic stress disorder (PTSD) worry that their flashbacks will be real;and those with generalized anxiety disorder (GAD) worry that, despite their worry, disaster will occur. People with chronic anxiety disorders are very sensitive to additional stress, and quickly become anxious and upset. They can develop additional symptoms, including those of other anxiety and depressive disorders. They know this, and commonly think that the seed of their disorder lies within their own nature, personality, or temperament. Perceiving their sensitivity to anxiety and their inability to cope with it, they deny or fail to control the events that generated the anxiety and try to cope by avoiding the situations that worsen their anxiety. They focus instead on the physical symptoms that are part of the anxiety response, or on the situations that provoke their anxiety, rather than trying to understand the meaning of their anxiety. The handicap comes from avoidance: the phobic avoidance, the compulsive rituals, the emotional numbing, the preoccupation with the possibility of physical illness, and from the time spent worrying.

Treatment should aim to reduce the emotional sensitivity to stress, the anticipatory anxiety about outcomes, and the avoidance behaviors related to specific situations. The book is written especially for psychiatrists and clinical psychologists to provide detailed knowledge about the process and pitfalls in conducting a comprehensive cognitive behavioral program for the common anxiety disorders.