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Anxiety Disorders in Adults. An evidenced-based approach to psychological treatment
  1. Robert J Edelmann, Honorary Professor, Chartered Clinical Psychologist
  1. University of Surrey Roehampton and University of Keele

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McLean, PD, Woody, SR. Anxiety Disorders in Adults. An evidenced-based approach to psychological treatment. Oxford: Oxford University Press,2001.

According to McLean and Woody, evidence-based practice involves “knowledge of the scientific findings, effective transfer of technology from science to practice and sound measurement of client progress (p10).” Their book aims to summarise treatment outcome studies and provide tips on how to assess progress during therapy. Given the vast and expanding literature about anxiety disorders and the difficulty of keeping our practice informed by current research, this is an admirable aim.

The book is part of the “Guidelines in Clinical Psychology” series edited by Beutler and Clarkin. One of the authors is a Professor of Psychiatry and the other an Assistant Professor of Psychology at the University of British Columbia. The book is organised into nine chapters and two appendices. The first chapter discusses the nature of evidence-based practice and presents a helpful overview of the notion of “scientist-practitioner.” The second chapter reviews the nature of anxiety and, in my opinion, is the weakest chapter in the book. The authors omit many theories of anxiety as an emotion. Chapters 3 to 8 focus on each of the DSMIV anxiety disorder groups: specific fears and phobias; social phobia; panic disorder and agoraphobia; obsessive compulsive disorder; post traumatic stress disorder, and generalised anxiety disorder. Each of these chapters is organised into four broad sections: a conceptualisation of the problem, theoretical perspectives, assessment and treatment models and guidelines. In each chapter, practitioners will find useful information, including details of questionnaires and rating scales as well as summaries of available therapies. The final chapter, ‘standards for quality care,’ is a unique aspect of this book. Most of the chapter is devoted to how to improve client outcomes at a local level, for instance within a group practice. Also useful, although by no means unique to this book, is the presentation of ten widely available scales for measuring anxiety and its disorders. There is also a summary of a small number of treatment manuals and resources in the appendices.

Overall then, this is a potentially useful book. In my opinion, however, it has three main drawbacks. First, the quality of the literature review: the references, with two exceptions, seem to be from 1998 and earlier. While there is an inevitable publication lead-in time for books, the literature referred to is less than current. Researchers and clinicians may be better advised to seek out Barlow’s authoritative and comprehensive overview.1

Second, while the authors do not claim to present a comprehensive overview of assessment methods, it is not clear what criteria have been used to select those that are presented. Those only available from test publishers are obviously not printed in full, but the tests that are presented are not necessarily the best for the task, nor the most widely used. Again, interested clinicians are more likely to seek out alternative sources of reference within each of the anxiety disorders.

Third, the book seems to be caught between two aims – it is neither an up-to-date review nor a comprehensive “how to do it” manual. Treatment approaches are described in varying degrees of depth, the main focus being to comment on the empirical support for any given intervention. The “how to do it” aspect is better provided for in other texts (for example, Wells 1997)2 and the literature is more comprehensively reviewed elsewhere.

Summarising the burgeoning literature pertaining to anxiety disorders is no easy task. McLean and Woody should be commended for their attempt to overview the literature and give a flavour of assessment methods and treatment strategies. The book has clear strengths, particularly its emphasis on encouraging therapists to think about their efficacy, evaluation and steps to improve client outcomes. In these cost conscious times, this book should encourage mental health practitioners to apply treatments that “work,” however, the corollaries referred to above are likely to militate against it being a “best seller.”

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