Although McMahon attempts to
provide a brief, "hands-on" synopsis of the current cognitive and
behavioral anxiety treatments in her book No More Anxiety: Be Your Own
Anxiety Coach, it appears that she has some difficulty in reaching this
goal. Firstly, her attempts to consolidate large amounts of material led to the
removal of important information and a lack of text coherence. Secondly, her
presented material was somewhat contradictory in nature. Thirdly, some of her
material is inaccurate.
McMahon's review of
cognitive-behavioral activities designed to reduce anxiety is poorly done. She
provides an overly-simplified explanation for the tools, which does not allow
the reader to fully understand the reasons behind them. She then makes a list
of few activities that the reader could engage in. I found the lists to be
paltry at best. Her consolidation of common thought distortions is so brief and
under-elaborated that many of her "types of negative thinking" appear
to overlap in definition. I also found the way that the book was written to be
confusing. McMahon frequently provided a short explanation for topics that were
covered in more detail later in the book. When I read the initial explanation
and examples, I was surprised to read the material again in longer version
later in the text. This "jumping around" made the book feel choppy
and lacking of coherency.
In the first chapter, McMahon
provides a wonderful description of the physical and cognitive sequelae of
stress. In her synopsis, she indicates that high levels of stress leads to
increased heart rate, respiration, and reduced immune system functioning. Later
under the chapter "Frequently Asked Questions" she states that "anxiety
is a really uncomfortable feelings with physical side effects, but that is all,"
suggesting that anxiety is innocuous. Which is it? Does anxiety tax the heart
and leave the immune system open to attacks, or is it harmless?† In the next
paragraph she states, "Anxiety does not cause mental illness".
However, anxiety is internationally listed as a mental illness in and of
itself.† Also in the chapter, "Frequently Asked Questions," McMahon
asks the questions "Why do I feel so tired" and "Would resting
be better for me," respectively. In answer to the first question, McMahon
indicates "your body is working hard producing and coping with a range of
stress hormones and their effects." In answer to the second question, she
confounds the words "rest" and "avoidance" and leads the
reader to believe that they should not rest. In all actuality, she needs to
communicate much more clearly on this topic. Under the topic "Relaxation
Exercises," McMahon states, "There are many forms of relaxation
exercises, ranging from those that require physical exertion, to those that
require nothing more than breathing or visualization techniques." In
current nomenclature, relaxation techniques are designed to immediately reduce
the rate at which the heart and lungs work, thus necessitating calming
McMahon states on the first page, "Cognitive-Behavior
Therapy is the only therapy that has sought to put itself forward for
assessment and validation through research." This is blatantly inaccurate.
All forms of therapy have used research as a means of assessment and validation
of its paradigms and techniques.† While discussing OCD, she refers to
obsessions as a "compulsive urge to take part in ritualized activities".
Clinically, this is a confusing and misleading definition. The obsession is the
thought and the compulsion is the behavior. In the above quote, she is
referring to the obsession as a compulsion. The reason that this may be
important is that it may impede later communication with a mental health
specialist. In addition, McMahon discourages pharmacological treatments of
anxiety, stating, "The problem with medication is that you end up having
to take more and more and the effects wear off more quickly." This is
untrue for the majority of the medications used to treat anxiety. Furthermore,
research indicates that only 40% of individuals are successfully treated via
therapy. Discouraging medication is therefore irresponsible, since the
idiosyncratic response to treatment and medication suggests that some will
react better to medication.
Overall, I felt that the author did
a poor job in both her explanations and recommendations. Her explanations
lacked some important detail, and were at times, misleading and incorrect. Her
recommendations were in some cases, poorly exemplified and limited. It appeared
that McMahon wanted to consolidate 50 years of stress research into a small,
user-friendly book. Although this is an important goal, I believe she provided
too "sketchy" of a summary to be of real lasting use for readers. In
addition, she "borrowed" concepts from other researchers without
giving them credit. For example, she provides an extract from a stress list,
whereby events that are stress inducing are listed in order to stress
induction. In the actual research, the authors gave the list of stress inducing
events (e.g., the birth of a baby, marital problems) and assigned them a value.
An individual could add up the values and determine their "stress"
level and see into what category of stress they fell (e.g., 10-100 points= low
stress; 101-300= moderate stress, and so on). McMahon did not include the full
chart, nor did she give credit to these researchers. In her book No More
Anxiety: Be Your Own Anxiety Coach, she merely provided a brief list of
some anxiety provoking activities. I think that this section could be much more
effective, if she had simply cited these authors and included the full chart.
In that way, she would have provided a richer explanation for what constitutes
stressful life events and the corresponding "Stress values," which in
turn, would have enhanced the information given to the reader.
I feel that McMahon was on the
right track, but missed her goal.
© 2006 Kathy Tiell
Tiell, Ph.D., Lawrence Technical University, Southfield, MI