ASDI's Dr. Sally Winston contributed to a list of myths, misconceptions and fabrications about anxiety disorders often encountered on the web that is posted on the ADAA website. Read it here: Myths and Misconceptions about Anxiety Disorders

Our colleague in Chicago, Dr. David Carbonell, has been working to expose less-than-reputable marketing of "Anxiety Treatment." An example of his efforts is summarized in a WGN-TV Chicago newscast that can be viewed at: http://www.youtube.com/watch?v=t_9c8Q_dH9Y . More about "anxiety scams" from Dr. Carbonell is available at: http://www.anxietycoach.com/anxietyscams.html

Our British colleague, Dr. Paul Salkovskis, has reviewed the Linden Method:

Review of "The Anxiety Disorder and Panic Attack Solution; The Linden Method":

Extraordinary Claims Require Extraordinary Evidence

Paul Salkovskis, Clinical Director, Maudsley Hospital Centre for Anxiety Disorders and Trauma

The claims made in this programme are bullish. We are asked to believe that this is the one true way to rid yourself of panic attacks, anxiety disorders and phobias. At one point it says that it is the only cure for anxiety. But before looking at the evidence for such extraordinary claims, lets look at the process.

Firstly, one has to learn the "nine pillars," read the material, do the visualisation exercise twice each day, do Tai Chi exercises as often as possible and do exactly what the Method teaches you. Confusingly, there are then two "powerful" elements; diversion which apparently re-balances the sufferer's conscious logical thinking and subconscious habits. Secondly, the sufferer needs to breathe correctly and improve their posture.

So what are the nine pillars?

Stop visiting your doctor (and other doctors too)
Talk to your doctor about stopping the medication (confusingly as you are not supposed to visit them)
Stop looking for answers to your problems elsewhere
Only use the Linden method
Stop talking to other people about how you feel
Stop relying on other people for help with your feelings (which follows from not talking to them presumably)
Get rid of memories about your problem
Keep busy as a diversion (distraction)
Don't allow anxiety to change what you do.

You don't have to be a psychologist to see that 1-7 are all ways of saying "rely on this method alone." That leaves two pillars which are about not giving in to anxiety. Good stuff, but not good enough.

Interestingly for someone who says that the way to getting better is not to dwell on the details of your past problems, Mr. Linden offers the story of his own problems in great detail in the "Nine Pillars" booklet. The story comes to its culmination when he received Cognitive-behaviour Therapy. His cognitive therapist taught him all kinds of useful stuff, which Linden applied and added to. I found myself musing about this. Why is this person, who benefited from cognitive therapy (and added to it in ways any sensible CBT therapist would encourage one to do) now taking the position that other people should not seek help from anyone except himself? I'm keeping my answers to myself, I'm afraid.

The Nine Pillars book then offers a reasonable account of the physiology of anxiety (although some of it made me wince). Nothing unique here, and certainly not the best account available. For someone opposed to the use of medication Linden seems very fond of biological accounts of anxiety. Oddly, although he seems to have benefited from cognitive-behavioural therapy, the cognitive component does not come through directly. For example, this early section on Panic Disorder he neglects to mention catastrophic misinterpretation of bodily sensations, choosing instead to suggest that the brain has been programmed to produce panic. Linden is also fond of diagnosis, and paraphrases the American diagnostic system as a way of describing anxiety disorders. This improves later as one listens to the CD based material, but the nuggets are well hidden.

The chapter on stopping anxiety has some good snippets, and Linden is fond of the idea of hyperventilation, resurrecting the old "brown paper bag" idea. Some other practical ideas are to be found in "diversion tactics"; these are good old fashioned distractions, varying from splashing water on the face to eating apples. Maybe he thinks an apple a day keeps the doctor away, so it fits with his first pillar? But there is another major problem here. He gives no consideration to safety seeking behaviour. This is a shame, because a lot of his "behavioural activation" stuff (meaning: don't let your behaviour be changed, reach for the things you want) fits with current views on and evidence about the role of safety seeking in anxiety disorders. However, in places he is implicitly encouraging safety seeking behaviours. This in my opinion is further evidence that Linden's science is, as best, muddled.

The supplementary materials are interesting. The introduction on the CD is a pleasant and slightly soporific lecture which re-iterates the positive message in the nine pillars book. In the interview which follows, we are treated to more of the same. The visualisation exercise is even more soporific. It follows the convention set by progressive muscular relaxation, and again is worth doing for its relaxation and distraction potential, if relaxation and distraction is what you need.

The "Panic Attack Eliminator" seemed more promising on the basis of its preamble. And I mean promising; the promise is there, right at the beginning; "this is the conclusive method for disarming panic attacks." Apparently it can work on the first occasion, but might take up to three times. In the rest of this seven minute wonder, the sufferer is told that they cause their own panic. "Place every square millimetre of your body in my trust" Linden intones. Go with it, let it do its worst. Discover that it can't do anything bad to you. At last, something resembling cognitive therapy! Not set up properly, but sensible. Fear of fear is emphasises, as are vicious circles. But they are not explained properly, and of course it is not fear of fear which is the problem in panic, but fear of the consequences of fear. Sadly, it is clear that this is not the conclusive method.

This is all a bit sad. One way of looking at it is that Charles Linden had cognitive behavioural therapy, found it helpful, embellished it and now markets it as his own one true way not just for the problem he had, but for all anxiety problems. It's not.

Now don't get me wrong, this is mostly sensible stuff for panic, and if it cost 5.99 at the bookshop, I'd be recommending it, suggesting that there might be useful snippets here and there.

My opinion is that it will be of no value to people whose anxiety is not fuelled by panic, and only limited value to most of those with severe and persistent panic. So would I recommend it in a limited way?

What makes any recommendation impossible is the cultic element. The explicit method is, use my method only (and pay my price for it). The National Institute for Clinical Excellence (NICE) anxiety guidelines are now available, summarising the best science. Cognitive behaviour therapy (CBT) is the treatment of choice. The Linden Method has no evidence underpinning it and therefore doesn't even make third choice for NICE, which is guided self help based on CBT principles. Charles Linden's method is not evidence based, the science is flawed and the price is ludicrous. In essence Linden claims this treatment is novel and effective; sadly, it seems likely that what is novel is not effective, and what is effective is not novel. My title for this review is that extraordinary claims require extraordinary evidence; there is no such evidence

Professor Paul M Salkovskis

Anxiety and Stress Disorders Institute of Maryland:
Treating anxiety disorders and stress-related disorders in Towson, Maryland, since 1978.