Table Of ContentANXIETY
Third edition
Anxiety is a complex phenomenon and a central feature of many psychological prob-
lems. This thoroughly revised third edition of Anxiety has been updated to include
astonishing developments in the clinical implementation of knowledge about anxiety.
In particular, this edition updates the reader with:
• anew chapter on health anxiety;
• a fully updated chapter on obsessive-compulsive disorders, including the concept of
mental contamination and the causes of obsessions;
• an account of advances in therapeutic techniques.
Unique in its combination of an introduction to the subject with comprehensive coverage
of the latest developments in research and practice, this book provides an excellent
breadth and depth of coverage, which all practising and trainee clinical psychologists
will find extremely informative.
Stanley Rachman is a clinical researcher, specializing in psychopathology and psy-
chological therapy. He is currently Professor Emeritus at the Institute of Psychiatry,
King’s College London and the University of British Columbia, Vancouver. His other
publications include The Treatment of Obsessions, Fear of Contamination, Panic Disorder
(with Padmal de Silva), andObsessive–Compulsive Disorder (with Padmal de Silva).
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Anxiety
Third Edition
Stanley Rachman
Third edition published 2013
by Psychology Press
27 Church Road, Hove, East Sussex BN3 2FA
Simultaneously published in the USAand Canada
by Psychology Press
711 Third Avenue, New York, NY10017
Psychology Press is an imprint of the Taylor & Francis Group, an informa business
©2013 Stanley Rachman
The right of Stanley Rachman to be identified as author of this
work has been asserted by him in accordance with sections 77
and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or
reproduced or utilized in any form or by any electronic,
mechanical, or other means, now known or hereafter
invented, including photocopying and recording, or in any
information storage or retrieval system, without permission
in writing from the publishers.
Trademark notice:Product or corporate names may be
trademarks or registered trademarks, and are used only for
identification and explanation without intent to infringe.
First edition published by Psychology Press 1998
Second edition published by Psychology Press 2004
British Library Cataloguing in Publication Data
Acatalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Rachman, Stanley.
Anxiety / Stanley Rachman. – 3rd Edition.
pages cm
1. Anxiety. 2. Anxiety disorders. I. Title.
RC531.R334 2013
616.85'22–dc23
2012042676
ISBN: 978–0–415–69707–1 (hbk)
ISBN: 978–0–415–69708–8 (pbk)
ISBN: 978–0–203–55449–4 (ebk)
Typeset in Palatino
by Keystroke, Station Road, Codsall, Wolverhampton
Contents
Series preface vii
Introduction to the third edition ix
Introduction to the second edition xi
1 The nature of anxiety 1
2 Fear,anxiety and avoidance 13
3 Influences on anxiety 29
4 Anxiety, attention, perception, memory and emotional
processing 41
5 Theories of anxiety 61
6 Specific phobias and the conditioning theory of fear 77
7 Panic and anxiety 93
8 Agoraphobia 121
9 Obsessions and compulsions 127
10 Health anxiety disorders 149
11 Social anxiety 171
12 Generalized anxiety disorder 183
13 Post-traumatic stress disorder (PTSD) 191
Some concluding remarks 205
Suggested reading 207
References 209
Index 231
v
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Series preface
Clinical Psychology: AModular Course was designed to overcome the
problems faced by the traditional textbook in conveying what psycho-
logical disorders are really like. All the books in the series, written by
leading scholars and practitioners in the field, can be read as stand-
alone texts, but they will also integrate with the other modules to form
acomprehensive resource in clinical psychology. Students of psychol-
ogy, medicine, nursing and social work, as well as busy practitioners in
many professions, often need an accessible but thorough introduction
to how people experience anxiety, depression, addiction or other
disorders, how common they are, and who is most likely to suffer
from them, as well as up-to-date research evidence on the causes and
available treatments. The series will appeal to those who want to go
deeper into the subject than the traditional textbook will allow, and
base their examination answers, research, projects, assignments or
practical decisions on a clearer and more rounded appreciation of the
clinical and research evidence.
Chris R. Brewin
Other titles in this series:
Depression, Second Edition
Constance Hammen and Edward Watkins
Stress and Trauma
Patricia A. Resick
Childhood Disorders, Second Edition
Philip C. Kendall and Jonathan S. Comer
vii
Schizophrenia
Max Birchwood and Chris Jackson
Eating and Weight Disorders
Carlos M. Grilo
Personality Disorders
Paul M. G. Emmelkamp and Jan Henk Kamphuis
Addictions, Second Edition
Maree Teesson, Wayne Hall, Heather Proudfoot and Louisa Degenhardt
viii SERIES PREFACE
Introduction to
the third edition
Anumber of important developments in the study of anxiety have
taken place since the early 2000s, and the findings are being incorpo-
rated into clinical practice. The most remarkable – indeed astonishing
–application of the new knowledge and techniques was undertaken
by the UK government in 2007. Recognizing that the provision of
psychological treatment in the National Health Service (NHS) was
insufficient and unsatisfactory, with long waiting lists and poor
standards, it was decided to adopt the National Institute for Health
and Clinical Excellence (NICE) guidelines for treating anxiety dis-
orders and depression. The treatment recommended for anxiety dis-
orders is cognitive behaviour therapy (CBT), but therewas a serious
shortage of trained therapists and therefore an extraordinarily ambiti-
ous training scheme was introduced in 2007. The aim was to reduce the
waiting times for a psychological assessment and possible treatment of
anxiety and depression from six months to two weeks, and improve
the quality of therapy by using the evidence-based treatments recom-
mended by NICE.
A large sum of money was set aside for training 8,000 new
therapists, starting with 3,000 in the first three years. An interim report
on the progress of the programme, Improving Access to Psychological
Therapies (IAPT), was published by a major contributor, Professor
David M. Clark, in 2012. Over 3,600 therapists had been trained by the
midpoint of the programme and ‘more than 300,000 patients are being
treated annually ... clinical and employment related outcomes are
generally in line with expectation’ (Clark 2012).
On the research side, useful progress has been made in enhancing
our understanding of anxiety disorders, notably post-traumatic stress
disorder (PTSD), social phobia, obsessive compulsive disorders and
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