Abstract
Generalized anxiety disorder (GAD) is a common co-occurring disorder and prognostic indicator for poor treatment outcomes, presenting a myriad of assessment, diagnostic, and treatment obstacles for clinicians. For clinician–researchers, GAD also presents a challenge to study. These obstacles are compounded by the fact that the research literature has historically divided by therapeutic philosophies (e.g., psychosocial vs. pharmacological). Not surprisingly, the quality of care for GAD is often suboptimal. As such, attempts to integrate the various theoretical constructs and treatment approaches are much needed to bridge the gap between research and practice. The author of this book is a social work practitioner, who is uniquely qualified for this undertaking. The book is a well-organized and well-written volume describing the prevalence, theoretical underpinnings, treatment models, and empirical basis for the assessment, diagnosis, and treatment of GAD across the life span. The target audience is broad, and includes not only social workers and other mental health professionals but also primary care physicians, nurses, clergy, pastoral counselors, and other allied health care providers. This is especially important given that primary care physicians and others outside of specialty mental health settings are at the frontline in detecting and treating GAD.
Important features of the book include the author’s ability to cull from and integrate the disparate empirical evidence in explaining the various treatment approaches. For those working with children or older adults, the chapter devoted to these special populations is detailed, balanced, and informative. The comprehensive reference list at the end of the book and appendices containing publically available, off-the-shelf assessment tools and questionnaires are also useful.
The structure of the book could have been improved with a few tables summarizing the various psychosocial and pharmacological treatment approaches for GAD, such as a chart presenting medication treatments and common dosage ranges. In addition, it would have been helpful for the author to include a section on the various neurobiological mechanisms of action associated with GAD from neuroimaging research and present findings from the emerging research literature on computer-assisted treatments for GAD. While the author succeeds in educating readers about this “enigmatic and paradoxical” disorder (p.125), it is not a skill-building treatment manual. Moreover, the author does not discuss the systemic barriers associated with educating and training clinicians in delivering evidence-based treatments such as cognitive–behavioral treatment. Research has shown that social work was one of the two degree-granting programs that had the largest percentage of programs not requiring a didactic and clinical supervision in evidence-based therapy (Weissman et al., 2006). Improving the delivery of care for individuals suffering from anxiety disorders will also require education, training, ongoing supervision, and fidelity monitoring in delivering evidence-based treatments. As such, this book will be a good companion text to other clinical treatment manuals for advanced courses in the assessment and diagnosis of mental health disorders, as well as for experienced social work practitioners and clinician–researchers.
Overall, this book is directly applicable to social work practice and research as the author presents in an objective way the empirical basis for the psychosocial and pharmacological treatments of GAD. This is no small feat given the expanding research base. Despite some of the shortcomings, future editions of the book will likely be well received as the empirical basis evolves and diagnostic criteria are refined with the release of the next iteration of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-V. For example, recent effectiveness research by Roy-Byrne et al. (2010) examining Coordinated Anxiety Learning and Management (CALM) compared to treatment-as-usual in primary care clinics found that patients in the CALM treatment condition had significantly greater improvement in global anxiety symptoms compared to the standard treatment condition (Roy-Byrne et al., 2010), offering a promising model for treating generalized anxiety in general health care office settings. In addition, new ideas for refining the diagnostic criteria and relabeling the disorder as generalized worry disorder, characterized by excessive anxiety and worry generalized to a number of events and activities for 3 months or more (Andrews et al., 2010) ultimately will call for further research and integration in clinical practice. No doubt, this will add to the need for future editions of this comprehensive, thoughtful, and practical primer on GAD.