Anxiety & Panic

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Overcoming the Fear of FearReview - Overcoming the Fear of Fear
How to Reduce Anxiety Sensitivity
by Margo C. Watt & Sherry H. Stewart
New Harbinger, 2009
Review by Chris Vaughan
Jan 26th 2010 (Volume 14, Issue 4)

Most people, when they encounter danger, experience fear, then confront or avoid the danger and when the danger has passed, allow the fear to subside and get on with their lives. However, while some people have difficulty in perceiving danger  in the first place, at the other end of the spectrum, some live in a constant state of hyperarousal and like faulty burglar alarms, have a hairtrigger response to the slightest provocation.  They suffer from Anxiety Sensitivity and this book is for them.

One of the problems that frequently dogs the literature in this field, is confusion and lack of clarity in the terms used. Separate but related states are lumped together under a single heading and one size-fits-all remedies are often proposed. So the authors are to be commended in their sharp delineation of terms and their careful mapping of this problematic area of therapy.

They usefully distinguish between fear and anxiety, terms often used interchangeably. Fear being the emotion provoked by actual danger. Anxiety the state engendered by thinking about possible danger.  Anxiety Sensitivity is the state of panic brought about by a reaction to the symptoms or effects of fear itself -- a term that has now come to replace the clumsy shorthand ‘fear of fear’. 

The authors show that people can misinterpret their symptoms in three separate ways. They can misinterpret them physically, seeing a racing heart, for instance, as a harbinger of a heart attack;  or psychologically , dizziness, say, or lack of control, as the sign of impending madness or socially, catastrophizing about the imagined consequences of appearing frightened in public .

Anxiety Sensitivity paying close attention to the sensations associated with anxiety and thus amplifying them -- is a risk factor for anxiety disorders such as panic, social phobia and post traumatic stress disorder.

However, Watt and Stewart don’t stop there. They maintain that AS has a major role to play in other morbidities not formally associated with anxiety and they show that depression, hypochondriasis, chronic pain, substance-use disorder and even menstrual distress can be linked to this high state of arousal.

Having established the critical nature of AS, even though they cannot pin down one single cause, they go on to provide a toolkit of techniques, with directions,  which anyone suffering from this condition and reluctant to seek professional help, can usefully apply to themselves to reduce their levels of AS. Anxiety Sensitivity, it should be noted,   is not something you eliminate. We all need a moderate amount to respond adequately to the threats in our environment.

The techniques proposed are familiar enough, such as dealing with automatic dysfunctional thinking, changing avoidance behavior, exposing oneself to the feared sensations and handling stress through a healthier lifestyle.

The authors set their tools within the transtheoretical model of change, pioneered by James Prochaska and Carlo DiClemente and others, so that anyone trying these remedies will know that their success hinges on them calculating their own stage of readiness to change and seeing relapse not as failure but as a temporary interruption in the process of change. They further buttress their arguments with Bandura’s concept of self-efficacy.

This book is an excellent summary of the latest thinking about excessive fear and anxiety and ways of reducing high levels of underlying Anxiety Sensitivity. The authors fulfill the criteria they say should be present in any good self-help book in that it should be solidly grounded in research, written by people well-qualified in training and experience and show some evidence that the book has “worked”. They go on to say that before releasing the book they have ensured that the program on which the book is based effectively helps people with high anxiety sensitivity, which is reassuring in a field bedeviled by exaggerated claims and quackery.

However, because the authors  alternate between satisfying their academic peers,  referencing their sources and establishing their evidence base in the manner  of academic discourse and then attempting to involve the general reader in their self-treatment with questionnaires, exercises and self assessments, the book fails  as a popular  self-help treatise.  If this is intended as a popular self-help treatise, and the front cover would suggest it is, then they need to emulate the practice of domestic appliance manufacturers by separating the quick start, easy to follow guide from the technical manual.

It is not a long book and the most competent analysis of a widespread problem I have seen to date.  It will prove an excellent introduction to the subject for students and a sound reference for therapists.  It will also act as a self-help book for those who feel they need to reduce their high AS index, providing, that is, they have a modicum of academic training.


© 2009 Chris Vaughan


Chris Vaughan writes about himself: I live in Birmingham, England. I am now retired after a career in the pharma industry and am very much involved in community activities. I am a board member of the Birmingham Environmental Partnership and chair a local patient network. I have written a book on the British Health Service and I currently write for a health website. I am very interested in the mind-body conundrum.


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