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In this modern age, a plethora of books in the field of psychology and psychiatry are increasingly educating on brain structures and functions in various conditions or practices. Many will still focus on psychological or social arenas of functioning in describing etiologies or interventions, but most are now considering the brain and neuronal substrates as primal.
In this offering the authors focus on the neurobiological bases of anxiety disorders and how to treat them, effectively.
Across 11 chapters, they discuss how the physical brain gives rise to the experience of anxiety, with the underpinning of the neurotransmitters as involved in the experience. They speak of the mindless fear that emerges out of the blue so often in panic disorder, and the baseless worrying of the generalized anxiety sufferer. In both cases, they refer to the treatment, as well as medication of the disorders, as they then do with social anxiety.
These illnesses are not trivial, especially in the workplace, where affected workers who continue to grind away at their jobs provide a huge source of loss for the economy, with estimates of a few years ago at the $44 Billion level each year, each worker who is one of the 'walking wounded' losing about 1.8 hours per day in productivity if the APA reports are to be accepted.
The opening chapter on the brain and the mind, and how each contributes to the experience of anxiety is very detailed, much more than other books of this type, with often complex flow charts demonstrating the principals involved, and no less complex is the next, focusing on neurotransmitters, moving rapidly from a simple discussion of neurons to brief but informing data on the messengers themselves.
The book clearly attempts to balance complete novices who themselves are searching for information, against the needs of professionals who may have gaps in their memory or training. You have to write well and concisely, and the author's skill in doing this well comes through. This is most evident in the treatment chapters that follow on to each of the three conditions dealt with, and the medication chapter that again follows in turn. They have simplified their approach into a three step procedure:
Address the physiology
From this, you will see that the approach uses the most validated procedure in such matters, at least as affective as medication, namely Cognitive Behavior Therapy, although there may be other approaches. What is a departure for some readers is the immediate targeting of the physiological signs and symptoms, rather than the cognitions, and the stepwise approach is a reasonable heuristic. Another emphasis is on the ruling out of the possible physical causes, which means the reader is looking at a true biopsychosocial approach, without the word being used anywhere in the book.
The book also takes pains to discuss each aspect of the treatment, such as psychoeducation, or diaphragmatic breathing, in detail, and in the usual clear style.
I am not entirely sure I agree with titles such as "Neurotransmitter dysfunctions that can generate panic symptoms"(p. 96) but I guess most will understand what they are trying to get at in cause-effect terms.
No one will think this book is seminal, or groundbreaking, or state of the art, but all will think it is useful. I have photocopied the odd table of techniques or feedback loops which pepper the text, and sent it off to colleagues, many of whom learned these facts, and forgot. Rich roundedness is often a key to solution in mental illness.
What this book reflects, without trying to I believe, is that the world's behavioral health and illness culture has moved towards a more integrated focus, not just on a medical model, or a pure Freudian psychophysiology, or even a neurology model, but a truly integrated, silo-broken look at how signs and symptoms inform on underlying integrated and polymorphic origins of illness. While not quite personalized medicine, these authors are leaning towards interfacing with a more vibrant entity, one which has many facets.
So we know now that the same genes encode for heart rate and anxiety, that there are genes or snippets of genes that dictate whether or not we can produce healing entities such as neurotrophic factors, which then dictate what medicine might work for what person.
But if the author's approach is correct, then a more integrated look at a client is necessary if one is to do justice to evolution. Darwin was of course a great integrationist, working inference backward in time to reach a more substantial response than creation.
As these authors note:
"New information about the complexity of the brain has proved that mental disorders develop from the complex interaction of neurobiology and life experiences. Advances in understanding brain structure and function have forever changed how we look at behavior....We know without doubt that nature and nurture are interdependent processes in development of identity, personality and mental health" (xi).
If this seeming trivial statement can be embraced as both culture and philosophy on a larger scale, then small books such as this may help guide practitioners out of the silo, following the assurances the authors give, above.
There is the science of anxiety, and there is what could be, and this little book gives a template of what might be, somewhat naïve, but valuable.
© 2007 Roy Sugarman
Roy Sugarman, PhD, Director of Clinical and Neuropsychological Services, Brain Resource Company, Ultimo, Australia