Dr. Patrizia Collard
Stress Management Consultant and Psychotherapist

CONTROLLING ANXIETY, William Stewart, Oxford: How To Books, 1998, pbk. L 9.99, pp.160.

This self-help book is subtitled: ’How to master fears and phobias and start living with confidence’. An important question is whether the book actually achieves what it sets out to do. It certainly helps the reader, sufferer and helper alike, to get a better understanding of the different types of anxiety people might have to put up with. Hence it gives a better factual understanding of the basic ‘dis-ease’ pattern. Thus the author is correct in claiming that knowledge and information is an essential tool in combating this crippling disorder. “I set out to write a book which contributes to the knowledge of what anxiety is … and to give you some strategies to help combat it.”(p. 140)

The author however falls short in a systematic approach to handling anxiety disorders, which, as many therapists will agree with, are very difficult to treat at any time. The reader will find a selection of strategies, alas too little in order to ‘master’ fears and phobias as we are let to believe in the subtitle of the book.

Let me be more specific. Two thirds of the book, that is 8 of 12 chapters mainly deal with identifying different types of fears and compulsions. Initially the general disease pattern is introduced, followed by self-tests and finally some case studies. More than once however I found the case studies too straightforward, the solutions to the individual problems too simplified.

For example Andy, a man in his forties, gets anxious when being alone at home. So he thinks back to other times when he has had the problem in the past. “Gradually he traces this feeling to the time when he was in hospital as a child. This insight removes the anxiety of being left alone.” Having had the privilege of training and working with ‘Phobic Action’ for several years, I must confess that I never came across a truly anxious person who changed their behaviour patterns just by finding out why they had developed them in the first place. It makes it sound so simple.

The author does acknowledge that stress aggravates anxiety and phobias and makes helpful suggestions in improving one’s lifestyle in general. Sometimes however Mr. Stewart again was not specific enough in distinguishing between what Isaac Marks calls ‘normal’ anxieties and fears (see “Living with Fear”, p. 30ff.) and irrational ones.

When the author discusses coping with anxiety over long-term illness (Ch. 10) for example, the case-study he chose to illustrate his point, namely the fears of long-term carers who see no way out, struck me of being quite ’normal’ under the circumstances. Here I see two people who are coping better than average with Multiple Sclerosis. They are of course feeling sorry for themselves and wonder how much longer they will be able to cope, but they are still going through it together, more than ten years after hearing the initial diagnosis. They are indeed desperate, but I can’t see how their fears are irrational and in need of treatment. In my view they have every reason to feel the way they do.
This is just one example where I feel the author has strayed a little too far from the topic he wanted to cover.

He does however include one topic, which has rarely been dealt with in the arena of anxiety management, and that is ‘eating disorders’. It is an interesting and probably valid point to claim that anorexia and bulimia are closely linked to feelings of humiliation and embarrassment, and constitute a kind of food-related OCD (“the mind of the bulimic is constantly full of thoughts about food”, p.80).

Finally, only the last two chapters deal directly and consistently with the question of combating anxiety. Here Mr. Stewart discusses questions such as cognitive restructuring, thought stopping, relaxation, breathing techniques and imagery work, self-esteem, autosuggestion and how to empower oneself. All these skills are in themselves extremely useful and necessary. But the author only gives us snippets of how these techniques work and can be acquired. I would have preferred one or two case studies where an array of techniques is applied to in detail, step by step, and how the person gradually changes. There is a lot of material but no in-depth-teaching. The inclusion of a relaxation-script might have been useful too.

It could be argued however that I am expecting too much of a self-help book. Maybe it is only meant to point people in the right direction. This is certainly something the author has achieved: basic education of the reader, some techniques that might be useful and foremost the importance of accepting oneself ‘warts and all’. Definitely a good read and introduction manual for the fresher first coming across the subject under discussion.

Patrizia Collard (PhD) Stress Management Consultant and Psychotherapist

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