798 Book Reviews

‘Bose-Einstein condensate’ (I do not claim to understand all of it), and her explanation of the mind/body dilemma in terms of the wave/particle duality of quantum theory cannot fail to ‘raise the consciousness’ of all psychologists.

Without being left-wing, feminist, or radical, Howitt attempts a mainstream critique of psychology which has so far not in any significant way been responsive to important social issues of our time.

A paper by John Raven, based on his address to the British Psychological Society’s Conference on the Future of Psychological Sciences in 1987, reproduced in The Psychologist of November 1989, had as its sub-title ‘Why psychology should replace economics as the key discipline in policy development’. He cited several instances in psychological research which Howitt would have applauded. Social relevance without losing objectivity or falling into narrow factionalism is an attainable goal for psychology.

The grammatical ambiguity in the title must be intentional. It is a meaningful wink of acknowledgement to post-modernism. I do not agree with everything that Howitt says in this book, but it demonstrates that knowledge can advance without having to be stated in terms of falsifiability or replicability.

MICEL JAYASINGHE

R. M. RAPEE and D. H. BARLOW (Eds): Chronic Anxiety: Generalized Anxiety Disorder and Mixed Anuiery-Depression, Guilford, New York (1991). x + 214 pp. $25.95.

The impetus for this volume arose from two sources. First, chronic anxiety states, such as generalized anxiety disorder (GAD), have long been neglected in the literature, despite their prevalence. Second, the DSM-IV anxiety disorders work group, chaired by David Barlow, was faced with the task of reviewing the diagnostic criteria for GAD and considering the possible introduction of a new category, mixed anxiety-depression. The present volume reflects some of these deliberations, and was intended to stimulate interest in the mechanisms and treatment of chronic anxiety.

Chronic anxiety, and GAD in particular, are examined from multiple perspectives, with chapters dealing with the diagnosis of GAD, the nature of its central feature-worry-and psychological and biological theories and treatments. The volume has many strengths, including a list of prominent contributors, and the presentation of results from unpublished data sets. A further strength is the discussion of psychological and biological factors, in an effort to present an integrated review. Despite these strengths, the book is disappointing in other respects. While the book is not lacking in breadth, a number of chapters are lacking in depth. Barlow, for example, in the opening chapter, provides only a sketch of a theory of anxiety and depression. He draws an interesting distinction between “reactive” and “endogenous” forms of anxiety and depression, but has little to say about the nature of this distinction.

One of the more stimulating (and controversial) chapters is contributed by Borkovec, Shadick and Hopkins, After reviewing the literature on worry, they present a model of the processes in normal and pathological worry. In Borkovec’s earlier work (e.g. Borkovec, Robinson, Pruzinsky & DePree, 1983) worry was conceptualized as a maladaptive means of anticipating and preparing for possible aversive events. This model was later elaborated by Mathews (1990). In the present volume, Borkovec appears to have abandoned this model in favour of the proposal that worry serves to reduce the generation of aversive images and other means of retrieving threat-relevant material from memory. This, in turn, is said to suppress aversive affective arousal. Thus, worry is said to be maintained by negative reinforcement: “Worry leads to the suppression of imagery; imagery is the most potent internal route to, or reflection of, memory representational link to affective-physiological response; thus, worry provides for the avoidance of aversive somatic cues. Worry is uncontrollable, frequent, and intense because it is immediately reinforced (outside the awareness of the individual) by suppression of somatic anxiety” (pp. 4445).

This model does not fit with evidence suggesting that the induction of worry primes threat-relevant memory structures, thus increasing anxiety (Eysenck, 1984; Mathews, 1990). Borkovec’s model is reminiscent of the strategy of coping with a toothache by producing a greater pain elsewhere (e.g. by stubbing your toe). If worry is a strategy designed to suppress intrusive images, then why not engage in pleasant self-statements or images instead of worry? Also, if people worry in order to avoid distressing imagery, then the reduction of worry in GAD should be associated with an increase in distressing intrusive images. There is no evidence that this occurs. Despite the implausible nature of Borkovec’s theory, it will no doubt prompt investigators to reexamine their assumptions about the causes and functions of worry.

In conclusion, the limitations of the volume, Chronic Anxiety, are outweighed by its strengths. The editors and contributors are likely to succeed in their aim of stimulating interest in the mechanisms and treatment of chronic anxiety; the volume clearly highlights how much remains to be learned about chronic anxiety and mixed anxiety-depression, and many chapters present testable hypotheses that are likely to encourage research in this area.

STEVEN TAYLOK

REFERENCES

Borkovec, T. D., Robinson, E., Pruzinsky, T. & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behauiour Research and Therapy, 21, 9-16.

Eysenck, M. W. (1984). Anxiety and the worry process. Bullerin of the Psychonomic Society, 22. 545-548. Mathews, A. (1990). Why worry? The cognitive function of anxiety. Behaviour Research and Therapy, 28, 455468.