The Anxiety & Worry Workbook: The Cognitive Behavioral Solution

Anxiety self-help manuals based on CBT are almost a genre unto themselves, but this is the first such book to bear the name of the field’s creator, Aaron T. Beck, as co-author. Designed as a companion volume for Clark and Beck’s definitive 2009 textbook Cognitive Therapy of Anxiety Disorders: Science and Practice, The Anxiety & Worry Workbook also stands exceptionally well on its own.

Rating: 4.5

The Anxiety & Worry Workbook: The Cognitive Behavioral Solution

By , 2012. ISBN 9781606239186. Guilford Press. 294 pages.

The Anxiety & Worry Workbook gives it to you straight: you can be your own cognitive therapist. This will not be news to anyone with even a passing familiarity with the field, but nonetheless perhaps it can serve as another counter-weight to the claims one sometimes encounters about the downright necessity of engaging in CBT only with fully-trained, fully-accredited-by-so-and-so cognitive therapists and CBT practitioners: members of the public drawing on a manual like this are very likely not going to be accredited or trained except for what they absorb via the book itself. While the authors highlight several times that for some people, some of the time, working through the book in conjunction with working with a therapist — who would, ideally, be familiar with the 2009 text — may yield better results, you won’t find any partisan table-banging here.

Although intended broadly for tackling anxiety and worry, the latter parts of the book in particular focus on panic, social anxiety and generalized anxiety and worry. As the authors explain, OCD and PTSD, which are included in the 2009 text, do not feature in this workbook, since “the core fear and manifestations of OCD and PTSD differ somewhat from those of other anxiety disorders” (p. 26). The final chapters (9 to 11) address each of these three focus areas in turn, offering specialized interventions and models appropriate to each. The bulk of the book (chapter 1 to chapter 8) is occupied with introducing cognitive therapy and the cognitive view of anxiety, creating a personal anxiety profile, and learning to apply highly individualised techniques and interventions.

That sense of being highly individualised, or personalised — which I would describe as a hallmark of modern CBT much more so than cognitive therapy in its earliest formulations — features strongly and repeatedly throughout The Anxiety & Worry Workbook, beginning right on page 2. This is not simply an algorithm being imparted to the reader, a specific set of steps which the reader will follow to ‘cure’ anxiety and worry. Rather, this is a methodological template into which the reader places their own individual thoughts, feelings, experiences, values, and goals. The book guides the reader in identifying the aspects of each which are salient to the treatment approach being explained, but the template does not ‘come alive’ as a therapeutic method until it is filled with the essentially individual and personal content provided by the reader.

While the content of the workbook is undeniably thorough, and the authors’ approach is at once robust and gentle, there were a few occasions — particularly in the final chapter, addressing generalized anxiety — where I wished either for an important point to be highlighted even more strongly, or for an underlying conceptual subtlety or weakness to be acknowledged clearly. As an example of the former, Clark and Beck note in connection with worry:

If correcting your catastrophic thinking through evidence gathering does not reduce your worry, you may be using evidence to reassure yourself that the worst won’t happen. Make sure you’re using evidence gathering only to correct your biased estimates of threat probability and severity. (pp. 264-265, emphasis original)

Given the earlier chapters’ repeated mantra on not retreating to safety behaviours, this absolutely crucial observation seems to me like it deserves more than a two-sentence aside (even if it was set off in one of the ‘Troubleshooting Tips’ boxes sprinkled liberally throughout the volume!).

And as an example of the latter, the authors give what I can only describe as a ‘hand waving’ explanation (p. 235-237) of how worry can become persistent and uncontrollable for some people, beginning with a set of “features of excessive worry that account for its persistence and uncontrollability” (p. 235). As a matter of basic science, however, such a set of features does not “account” for anything of the sort, except to the extent that those features already include persistence or uncontrollability by definition. (One of the features is actually “failed worry control”!) In my view, however, there is a general inclination in the cognitive therapy literature to write as if CBT is actually a robust scientific theory of how humans think and behave (which it is not), as distinct from a robustly scientifically tested method of reducing particular symptoms (which it is) — and for that reason I would not necessarily count this hand waving against the book. It is, rather, a reflection of a broader neglect of basic concepts of philosophy of science (where this type of hand waving is sometimes referred to as a ‘just-so story’).

Quibbles like these aside, I would not hesitate to recommend The Anxiety & Worry Workbook to anyone interested in learning more about cognitive and cognitive behavioural approaches to anxiety — therapist and client alike. If you’re a CBT practitioner, and in particular if you’re already well versed in the authors’ 2009 textbook, this workbook should be in your arsenal. Even if you’re not — and certainly if you’re interested in addressing your anxiety and worry — then it deserves a look.

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