This book aims to make accessible to the reader a wide range of topics concerning generalized anxiety disorder (GAD), with an eye towards the treatment professional. It is written by a doctoral-level clinical social worker, Dr Michael Portman, inspired by his own journey in encountering, studying, and treating this often misdiagnosed and misunderstood condition. Its style and content reflect that journey, as the author reviews the extant knowledge regarding GAD from the basic and clinical research literature, starting with its origins and evolution as a diagnostic entity, moving onto methods of assessment and diagnosis, followed by a major review on its conceptual models and treatment approaches. In that spirit, this book sets itself apart from (1) treatment manuals for GAD, with their nuts-and-bolts ‘how to’ approach, and (2) multi-author volumes that provide more in-depth treatment of some aspects of this condition while neglecting others.

This book is laid out in eight chapters that cover diverse aspects of GAD important for clinical professionals. Chapter 1 provides a general overview of the condition, reviewing its nosological history, epidemiology, and basic clinical presentation. It forms the contextual basis for understanding GAD as a psychiatric condition. Chapter 2 delves into more in-depth methods of assessing worry, generalized anxiety symptoms, and GAD. Several of the main clinical instruments discussed are usefully included in the appendices. Chapter 3 highlights the various psychological models that attempt to explain the basis of excessive worry that lies at the heart of GAD. In a rough chronological manner in which one model builds upon or diverges from prior ones, the author explains the main tenets of each theory and the research basis, where available, that supports them. Chapter 4 reviews the main psychological treatments for GAD, including cognitive behavioural therapy, meta-cognitive therapy, psychodynamic therapy, emotion regulation therapy, acceptance-based behaviour therapy, and integrative psychotherapy. Most of these have wide applicability for other anxiety and related disorders, but the author focuses on their use in GAD. This chapter also cites the findings of clinical trials using each of these therapies. Chapter 5 examines some of the biological aspects of GAD, including what little is known about its genetic and neurobiology underpinnings, but it wisely stops short of attempting to review the expanding neuroimaging literature. Although Dr Portman is a psychotherapist and not a physician, in this chapter he also provides a balanced perspective by emphasizing the importance of pharmacological treatment options for sufferers of GAD. As he did for psychotherapeutic approaches, the author reviews the clinical trials literature for each medication class used to treat this condition. Chapter 6 offers insight into the manifestations of GAD in paediatric and geriatric populations together with assessment and treatment methods useful for them, thus satisfying the title's promise to examine GAD ‘across the lifespan’. Chapter 7, entitled, ‘Enigmas and Paradoxes’, except for a brief reference to GAD's ongoing misunderstood disposition among psychiatric disorders, functions mainly as an opportunity to touch upon miscellaneous topics that (as one would expect) have little available data: prevention, cultural considerations, and treatment resistance.

I liked Dr Portman's honest, data-driven approach. He chose some key aspects of GAD and covered them practically but rigorously (with support from an encyclopaedic list of references 37 pages in length). The author is not a researcher or treatment originator himself, but rather, an informed user of the available knowledge base about GAD. This position allows him, in some cases, to more easily convey these concepts to the next potential user. In his thorough reviews of conceptual models and treatments strategies, he is careful not to interject his own biases and opinions, but rather, lays out the knowledge base for the reader to assess and utilize on his or her own. It is regrettable that Dr Portman is not able to, without deviating from the style chosen for this volume, include examples of how he has applied this diverse range of acquired knowledge in his own caseload of patients.

In his ‘Final Remarks’, Dr Portman communicates to the reader several interpretations of ‘integrative’ alluded to in the second part of the book's title. He emphasizes the need to approach each patient individually and without a ‘one size fits all’ mentality to treatment. He also stresses the importance of a multimodal attack on GAD, given any single treatment's limited potential for efficacy. Finally, Dr Portman conveys that, in order to achieve maximally acceptable outcomes for the utmost benefit of the patient, integration must include not only a diverse armamentarium of varied psychological and medical strategies, but also a humane and authentic therapist–patient relationship. This book is recommended to a broad audience of professionals in varying stages of training and focus who wish to more fully understand GAD from a broad, yet practical, clinically relevant perspective.