New Harbinger Publications has just released the updated fourth edition of their best-selling Anxiety and Phobia Workbook (over 600,000 in print!). Included in this new edition is a chapter on herbs and supplements which are marketed for anxiety. Yoga, meditation and mindfulness approaches have also been emphasized in this new edition.

Bourne includes updated information from the fast-growing field of neurobiology, including very interesting findings regarding fear pathways in the brain. It is now known that there are two fear pathways - a fast pathway mediated by the amygdala, that mobilizes us to flee a threat very quickly; and a slower pathway, mediated by the prefrontal cortex that takes several milliseconds longer and can interpret whether a stimulus is truly dangerous.

If the prefrontal cortex determines the danger to be false, it can then slow down the rapid amygdala activation. This has important implications for the treatment of the various anxiety disorders: panic, phobias and generalized anxiety appear to involve the fast pathway, while obsessive-compulsive disorder involves the slower pathway. Thus cognitive-behavioral interventions and medications can now be more specifically targeted to have maximum effect for the symptoms that are present.

Updated information is included on genetic predisposition to anxiety, the impact of the increased risk of terrorism in the world, and new understandings of the effects of nutrition on anxiety symptoms. Up-to-date information on new medications and guidelines for benzodiazepine and Paxil withdrawal have been added.

Bourne devotes a chapter to health conditions that can trigger or exacerbate anxiety symptoms, including adrenal exhaustion, thyroid imbalances, candidiasis, general body toxicity, premenstrual syndrome, menopause, seasonal affective disorder and insomnia. He urges anxiety sufferers to obtain medical advice to rule out any of these causes.

Basic information on all aspects of treating anxiety is represented, with chapters on relaxation, physical exercise, coping with panic attacks, treating phobias, using self-talk, dealing with mistaken beliefs, personality styles that perpetuate anxiety, visualization, expression of emotion, assertiveness, self-esteem, medication, nutrition and finding personal meaning.

Meditation is increasingly being accepted as a mainstream treatment for both anxiety and depression. Recent research has found regular meditation practice to be helpful in treating generalized anxiety disorder and in preventing relapse in people who have suffered episodes of major depression. Chapter 18 introduces the basic forms of meditation, with easy, step-by-step instructions for the beginning meditator, as well as a thorough explanation of how meditation helps with the anxiety disorders.

The Anxiety and Phobia Workbook is a 432-page large format paperback which is encyclopedic in scope. This resource for both psychotherapists and anxiety sufferers is highly recommended. The approach is practical, with clearly-written chapters on all aspects of anxiety symptoms and the wide variety of treatment approaches available.

Bourne's practical and encouraging tone is comforting to the reader; one feels in good hands with this comprehensive and thorough guidebook. If you or a family member struggle with some form of anxiety, order this book now! You will be glad you did.

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