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Generalized Anxiety Disorder Across the LifespanReview - Generalized Anxiety Disorder Across the Lifespan
An Integrative Approach
by Michael E. Portman
Springer, 2009
Review by Stephanie Sarkis, Ph.D.
Dec 7th 2010 (Volume 14, Issue 49)

Dr. Michael E. Portman writes in the Preface of Generalized anxiety disorder across the lifespan: An integrative approach that one of his main motivations for writing the book was to "present a comprehensive, albeit not exhaustive, source for clinicians by a clinician experienced in the theoretical underpinnings and treatments for GAD" (p. ix).  The author writes that another motivating factor was that as a clinician, he has "witnessed firsthand the ravage this disorder can cause" and "it has become even more pressing (akin to a calling to present not just 'another' text on the subject, but one that does justice to the marked impairment this condition can have on the individual sufferer and the larger societal impact" (p. ix).  The author writes, "GAD is a formidable foe for not just the sufferer, but for the practitioner" (p. ix). 

Dr. Michael E. Portman has a Doctorate in Philosophy and is a clinical social worker at Cleveland Veteran's Administration.  He is also an adjunct faculty member at Case Western Reserve University.  The books Foreword was written by John H. Riskind Ph.D., a professor of psychology at George Mason University.

The book is comprised of eight chapters:  Nature of Generalized Anxiety Disorder; Diagnosis and Assessment; Conceptual Models; Psychosocial Treatments for Those with Generalized Anxiety Disorder; Pharmacotherapy of Generalized Anxiety Disorder; Special Populations; Enigmas and Paradoxes; and Future Directions and Recommendations.  The book also has two appendixes:  Appendix A, Assessment Tools for Adults and Older Adults; and Appendix B, Assessment Tools for Children and Adolescents. 

Chapter 1, "Nature of Generalized Anxiety Disorder" discusses the following topics:  Historical Overview; Prevalence; Clinical Presentation; Onset, Course, and Prognosis; Comorbidity; and Impact on Self Others, and Society.

Chapter 2, "Diagnosis and Assessment" discusses the following topics: DSM-IV-TR: Diagnostic Criteria for Generalized Anxiety Disorder; Assessment; The Clinical Interview; Structured Interviews; and Self-Report Measures. 

Chapter 3, "Conceptual Models" discusses the following topics: Beck's Model; Barlow's Emotion Theory; Cognitive Avoidance Theory of Worry; Riskind's Model of Looming Vulnerability; The Role of Intolerance of Uncertainty; and Metacognitive Model.

Chapter 4, "Psychosocial Treatments for Those with Generalized Anxiety Disorder", discusses the following topics: Cognitive Behavioral Therapy; Metacognitive Therapy; Supportive-Expressive Psychodynamic Therapy; Integrative Psychotherapy; Emotion Regulation Therapy; and Acceptance-Based Behavior Therapy.

Chapter 5, "Pharmacotherapy of Generalized Anxiety Disorder" discusses the following topics: Genetics; Neurobiology; and Medications Used for Generalized Anxiety Disorder.

Chapter 6, "Special Populations", discusses the clinical presentation, assessment and diagnosis, psychosocial treatments and pharmacological treatments of children and adolescents and older adults. 

Chapter 7, "Enigmas and Paradoxes" discusses the following topics: Prevention; Cultural Considerations; and Treatment-Resistant Generalized Anxiety Disorder.

In Chapter 2, "Diagnosis and Assessment", the author not only provides the DSM-IV-TR diagnostic criteria for GAD, but also discusses comorbid and differential diagnoses. In addition to discussing instruments that can be used for a structured clinical interview, the author also provides a synopsis of three self-report measures: the Depression Anxiety Stress Scales (DASS), the Penn State Worry Questionnaire (PSWQ), and the Generalized Anxiety Disorder Questionnaire (GADQ-IV).   The author provides the DASS, PSWQ, and GADQ-IV instruments (in addition to two other instruments) in Appendix A of the book.  The child and parent versions of the PSWQ are provided in Appendix B.

In Chapter 3, "Conceptual Models", the author gives details of a number of psychological theories of GAD, including Barlow's Emotion Theory and Riskind's Model of Looming Vulnerability.  For each theory, the author gives the history of the theory, its main tenets, supporting studies, and future directions for research and expansion of the theory.  It is informative and yet also easy to read for a clinician that is not familiar with a particular theory. 

In Chapter 6, "Special Populations", the author discusses GAD and how it affects pediatric and geriatric patients.   The author gives synopses of five GAD assessment scales specifically for use with a pediatric population, and provides two scales in Appendix B.  The section on pharmacological treatment discusses studies with benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), and selective norepinephrine reuptake inhibitors (SNRIs).  For the geriatric population, the author gives a synopsis of an assessment instrument specifically for an older population -- The Worry Scale for Older Adults (WS).  The author provides this scale in Appendix A. 

In Chapter 7, "Enigmas and Paradoxes", the author addresses prevention of GAD, and gives the details of a study where a prevention workshop was given for college students over a three-year period, resulting in "fewer episodes of GAD and decreased anxiety symptoms, compared to the control group" (p. 112).  Multicultural considerations in the treatment of GAD are also addressed.  Studies of a variety of cultural groups are discussed in the chapter, including a study which found Nepalese patients had a higher rate of somatic complaints than American patients. Another study found that the prevalence of panic disorder and GAD in Lesotho was at an equal or greater rate than in the United States.

Generalized anxiety disorder across the lifespan: An integrative approach is well-cited with relevant and up-to-date articles.  There are 37 pages of references (this is approximately 16 percent of the book).  The book is a very valuable tool for clinicians, whether they work in a mental health setting or are in general medical practice.  It covers all aspects of GAD:  biological, social, psychological, and medical.  It also has valuable insights and recommendations using the highest standard of care in helping the GAD patient.

 

© 2010 Stephanie Sarkis

 

Dr. Stephanie Sarkis is the author of four books: 10 Simple Solutions to Adult ADD: How to Overcome Chronic Distraction & Accomplish Your Goals (2006); Making the Grade with ADD: A Student's Guide to Succeeding in College with Attention Deficit Disorder (2008); ADD and Your Money: A Guide to Personal Finance for Adults with Attention Deficit Disorder (2009); and Adult ADD: A Guide for the Newly Diagnosed (2011).  Dr. Sarkis is a National Certified Counselor (NCC) and Licensed Mental Health Counselor (LMHC) based in Boca Raton, Florida.  Her website is www.stephaniesarkis.com. 


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