Clinical Psychology Review 26 (2006) 105 – 106

Book review

David H. Barlow, Anxiety and its disorders: The nature and treatment of anxiety and panic, 2nd edition, New
York: the Guildford Press, 2002, 704 pp.

In his 1988 tour de force, bAnxiety and its Disorders,Q David Barlow drew on a vast theoretical and empirical
literature to describe the inherently future-oriented nature of anxiety, with its signature anticipation and expectation.
As one might have banticipated,Q the thoroughly revised and expanded second edition of Anxiety and its Disorders
fulfills all expectations.
The passing years have seen great advances in our understanding and treatment of anxiety and anxiety-based
disorders, with great strides in both psychology and neurobiology. This ever-expanding knowledge base is covered
exhaustively here: The 550 pages of rich, well-crafted text are followed by 125 pages of references—over 2500
citations in total! The reference section alone is a tribute to Dr. Barlow’s scholarship and merits purchase of the book
as a reference resource.
The introductory chapter is revised and expanded, covering diverse topics and striking the right balance of breadth
and depth. Topics covered include historical perspectives on anxiety, the comorbidity of anxiety with other disorders,
epidemiology, and gender and cross-cultural parameters. The second chapter is an empirically and theoretically rich
overview of emotion theory as applied to anxiety and fear, including a terrific historical review spanning theorists
from Darwin and James-Lange to contemporaries like Lang, Beck, Tellegen, and Izard. The third chapter represents a
thoughtful revision of Barlow’s elegant theory of anxiety postulated in the first edition, with an updated review of the
classic studies on anxiety and sexual arousal and particular emphasis on cognition and affect.
Like the first edition, the new volume includes a chapter on each of the Anxiety Disorders subtypes, this time co-
authored by contributing writers each of whom are renowned experts in their own right including the likes of Tim
Brown, Gail Steketee, and Terry Keane. A thought-provoking segue to these disorder-specific chapters is chapter 9,
which presents a critical discussion of the DSM-IV classification system of Anxiety Disorders (for which Dr. Barlow
himself vice-chaired the Work Group). The chapter discusses issues of reliability and validity of diagnoses,
comorbidity rates, and both nosological and theoretical aspects of classification schemas. As the authors warn,
bclinicians and investigators should not assume complacently that this system represents reality. . .Q
This caveat heeded, chapters 10–15 review Panic Disorder and Agoraphobia, Specific Phobias, Posttraumatic
Stress Disorder, Social Phobia, Generalized Anxiety Disorder, and Obsessive–Compulsive Disorder. Each chapter
provides a wealth of up-to-date information, with reasonable consistency across chapters in topics covered, including
history, etiology, diagnosis, prevalence, onset and course, comorbidities, gender/cultural variation, and assessment
and treatment (including pharmacology). The empirical approach and theoretical bent in each of these chapters is
strong. For example, a theoretically driven review of the literature on social anxiety (chapter 13) compares different
cognitive–behavioral approaches and emphasizes the importance of exposure-based treatment for circumscribed fears
(e.g., public speaking), but predicts that cognitive therapy will prove more effective for generalized Social Phobia and
Avoidant Personality Disorder. These chapters provide critical and concise reviews of the treatment literature, but do
not provide the clinical bhow to,Q and readers looking for that material will have to look elsewhere.
The book is an ideal reference for anyone hoping to understand the full nuance and complexity of anxiety with a
truly biopsychosocial perspective. It should be required reading of graduate students in psychology (as the first edition
was for me during my graduate studies), as well as other behavioral health professionals. Even if one were not
particularly interested in anxiety, Dr. Barlow’s ability to blend theory and data from both biological and psychological
science into a cogent whole merits the book’s consideration as a model for how this can be done. And, if nothing else,
the reference section alone merits purchase of the book as a scholarly resource.

doi:10.1016/j.cpr.2005.10.001
106 Book review

At its core, Barlow’s model emphasizes the sense of buncontrollabilityQ that lies at the heart of anxiety. Fittingly,
Barlow revives his dedication of the book to his now adult children, adapted from the first volume: bMay you
continue to retain your illusion of control.Q Unfortunately, the power and complexity of anxiety described so clearly in
this text suggests that we may never come to fully master or control it. Perhaps the closest we can come at present is to
read and absorb as much as we can from this marvelous book. Dr. Barlow, may your second edition of bAnxiety and
Its DisordersQ continue to retain its position among masterful and matchless works in behavioral science.

Andrew W. Meisler
VA Connecticut Healthcare System and Department of Psychiatry,
Yale University School of Medicine, USA
E-mail address: andrew.meisler@med.va.gov.