Anxiety + Depression: Effective Treatment of the Big Two Co-Occurring Disorders. Margaret Wehrenberg (2014) New York: W.W. Norton & Company. pp xi–304.


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Excerpt

Dr. Margaret Wehrenberg’s “Anxiety + Depression” bills itself as a treatment guide for therapists managing comorbid anxiety and depression in an outpatient setting. That said, the book proves useful to the psychiatrist/therapist as well. The patient population on which the author focuses is one with less severe symptoms, and it is clear that issues such as suicidality and the more severe mood disorders are beyond the scope of the book. However, it demonstrates usefulness to clinicians by outlining treatment strategies for managing various presentations of less complicated depression and anxiety. Given that depression and anxiety are both so common in an outpatient clinical practice and that the two commonly co-occur, a practitioner can easily fall into a pattern of using the same treatment approach for every patient. However, by providing a taxonomy of various presentations, this book serves to encourage the treatment provider to look a little closer and develop a more individualized treatment plan geared to the specific variables of anxiety and depression that are most pressing in a particular patient.The bulk of the book focuses on breaking down and defining seven different combinations of anxiety and depression encountered in the clinical setting, based on the most impairing symptoms for the patient. The author uses names such as “The Low-Energy Client” and “The High-Energy Anxious and Depressed Client” that make it abundantly clear that these different types of patients will have different strengths to draw from as well as different obstacles to overcome. Subsequently, the book easily serves to prompt the provider to move away from a one-size-fits-all approach to managing these disorders.Most chapters focus on one of the seven presentations of anxiety and depression, such as “The Worried & Exhausted Client.” A synopsis of the more pertinent symptoms of each disorder in the particular presentation is outlined. Generally, two cases are used to better illustrate clinical issues and obstacles. The selection of case reports is fairly diverse in patient age, sex, and psychosocial stressors. The provider is then prompted to consider factors relative to the assessment of each case—physical health, readiness to change, and mental energy. To the provider with a medical background, the physical health assessment may seem a little cursory, but it is good to see a comprehensive assessment encouraged, nonetheless. Readiness to change provides thoughts on the strengths and weaknesses that each anxious/depressed combination brings with it, as well as ideas a therapist may use to help the patient toward recovery. Mental energy ties into this process as well but focuses a little more closely on how factors such as fatigue, poor concentration, and rumination may change the treatment approach.Chapters then examine the therapeutic relationship for various patient populations. For example, when dealing with an individual who fits the archetype of a “Hopeless Ruminator,” the practitioner is cautioned to be aware of the patient’s sensitivity to disapproval. Case vignettes are brought back to help clarify these issues further. As an aside, the book does a good job of taking developmental issues and attachment into account and showing how they can contribute to the presentation as well as the working relationship with the therapist. Next chapters move into addressing the specific symptoms. Generally, all chapters have suggestions for lifestyle changes and general health considerations. However, therapeutic approaches vary greatly depending on the primary presenting issues. Overall, the specific therapeutic tools are sensible and well grounded in cognitive behavioral strategies. At times, the book briefly touches on a therapeutic approach, such as eye-movement desensitization and reprocessing, that it does not plan to fully explore.

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