The British Journal of Psychiatry
Principles and Practice of Stress Management (3rd edn)
Florian Ruths

Something strange happened when I opened the parcel containing this book for review: lifting 1.5 kg of a whopper, I felt my heart sinking, sweat dripped off my front and I became shaky. I now know: I was stressed.

Struggling with the conceptual haziness of stress (was it more anxiety about not completing this review before the London Olympics or depression over the thought of being a failure in not being able to read 800 pages?) I felt reassured after reading chapter 1: ‘Stress is an umbrella concept allowing a layperson to describe the perturbations of life without needing to face potentially undesirable terms like “anxiety” and “ depression”.’ If the concept is so loosely defined, how can we really advocate very specific solutions and management plans? The book provides a wise answer to this question: the broader concept of stress allows for a whole variety of interventions, ranging from muscle relaxation, hypnotic methods, breathing retraining and Eastern disciplines like Yoga and Qigong to cognitive methods and others.

In the introduction, Jonathan Smith writes somewhat vaguely about the psychology of relaxation. Vagueness seems to fluctuate throughout; in the presentation of randomised controlled trial data and effect sizes v. case studies, the different treatment approaches reflect the underlying differences in conceptual and epistemological thinking of the contributing authors.

The usual suspects, cognitive and behavioural interventions including Meichenbaums’s stress inoculation therapy and Kabat-Zinn’s mindfulness-based stress reduction, seem to provide the most solid research base for efficacy in stress management, as does exercise therapy. Other less well-known interventions also seem to have a role. Drawing on the knowledge of traditional Chinese medicine, Qigong provides anecdotal relief for the symptoms of stress through ‘emptying your mind and drawing energy from planets’. Neurofeedback helps you learn how to modulate your own electroencephalogram patterns and electrodermal responses as biological markers of stress. Music therapy seems to have an effect only if the music listened to ‘corresponds to the patient’s taste’. No wonder my blood pressure remained high while listening to Wagner’s Ring for relaxation.

In summary, this reference book gives us a remarkable insight into the huge variety of interventions available for the universal ailment of stress. Even though the majority of the interventions listed do not have a strong evidence base for their efficacy, this book teaches us to be cautious and to keep an open mind about somewhat New Age interventions. Who, after all, would have predicted 20 years ago that mindfulness-based interventions would be endorsed by the National Institute for Health and Clinical Excellence for relapse prevention in depression?