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Anxiety and Phobias

Stress and anxiety have been with us since the beginning of mankind and with the increase in pressure from modern society, more and more people are suffering either the psychological or physical aspects of stress. Approximately, 1 in 10 of the population suffers from anxiety states and a large number of this group will suffer from phobias (irrational fears) as well. Burnout syndromes are very common in the work situation, where the person feels apathetic and disinterested in their job and virtually become phobic about attending the workplace. It is important to achieve a balance between too much and too little stress in our lives and people in high stress jobs, are just as vulnerable as people who are underperforming and are bored with their routine existence.

This article is written by Dr Adrian Winbow, Consultant Psychiatrist, Harley St, London.


Causes

Some degree of stress is important in our everyday lives to help to motivate us and we cannot live without this. Man is an animal, and as animals, we respond to stress with the "flight or fight syndrome”. This produces adrenaline so that we can flee or fight our aggressors.

However, in modern day society, we are unable to do this, so that the adrenaline gets turned on ourselves, producing anxiety symptoms. Obviously, some of us have long standing anxious personalities which can be traced back to early childhood and this group of people are more prone to developing anxiety states than the general population. However, everybody can develop anxiety if they are placed under sufficient stress.

Certain life events have been shown very clearly to relate to our performance and anxiety symptoms. Any change in our lives can be anxiety provoking. Grief is a common cause for anxiety where there is loss either through bereavement, divorce, loss of job, loss of financial status, change of house or our children leaving home. All of these life events produce a change in our life pattern and depending on the flexibility of our personality, we cope with them in different ways.

Symptoms of stress

  • palpitations
  • rapid heart beat 
  • apprehension
  • shortness of breath 
  • feelings of anxiety and depression
  • choking sensations 
  • irritability
  • hyperventilation where we have short shallow breathing
  • hostility
  • churning in the stomach
  • marked feelings of frustration
  • nausea
  • vomiting 
  • nervous diarrhoea
  • disturbed sleep pattern
  • frequency of passing urine
  • agitation
  • weakness at the knees
  • talking too quickly and loudly
  • pins and needles sensations
  • hand tremor
  • tension headaches 
  • sweating
  • dizziness

and often, in a panic attack, a feeling that we are going to collapse and die.

Most people with anxiety become rather concerned about their physical health and feel that they are seriously physically ill. However, the mind is a powerful organ and it produces these psychosomatic symptoms. Hence, when we're under severe stress, we are more prone to develop phobias, which may start when we have an acute panic attack in a specific situation, such as a supermarket, crowded shops, buses, trains, undergrounds and lifts.

Agoraphobia which is a fear of open spaces, is extremely common in women and this prevents them from leading normal lives, because they use the avoidance response frequently to cope with their panic attacks. In other words, they avoid going into situations which make them feel anxious and this increasingly limits their lifestyle.

Social phobia is more common in men and in these situations, the man is frightened of public speaking, authority figures and social situations.

Treatment

Psychological Treatments

The person who is suffering severe anxiety is out of control regarding their life and needs to regain control as rapidly as possible. There is often a temptation to blame external factors when this happens and the problem often lies within ourselves.

If work is the major cause of stress, it is important to organise your work routine and maintain efficiency and enjoyment in the work situation. It is also valuable to allow sufficient time to complete the task and to learn to say 'no' when you are asked to do too many things at once and this takes in the need to delegate work to other people. Balancing your time is necessary between work, family social life and hobbies and leisure pursuits. Exercise is also important for 'burning off' the excess adrenaline and helping to relieve the anxiety symptoms. 

More specific relaxation techniques include relaxation therapy, yoga, transcendental meditation, hypnosis and massage. If the person has a specific phobia, then a combination of relaxation and behaviour therapy is very effective.

Cognitive behaviour therapy is a way of modifying the response to the phobia and is often carried out in a slow 'step ladder' approach to gradually reverse the phobia. The person has to pursue increasingly more difficult tasks, whilst using relaxation therapy, to help to cope with their anxiety symptoms.

Psychotherapy is also very effective for those people who have unconscious conflicts which can be traced back to early childhood, which are producing marked anxiety symptoms at present. Psychotherapy is a process of talking about these fears and difficulties in detail.

For a certain group of people who lack assertion or self-esteem, assertion training, self-esteem enhancement, and social skills training are also effective techniques to help them to relieve these problems.

Drug Treatments

A large number of patients receive drug treatment for their phobias and also anxiety states. Minor tranquillisers or benzodiazepines are very useful for relieving anxiety, but should only be given for a short course of no more than 4 to 6 weeks. However, there has been considerable discussion about the risk of addiction with this medication.

Beta blocker drugs are also helpful for relieving psychosomatic symptoms of anxiety, as they block adrenaline which causes these symptoms and these drugs are not addictive.

Antidepressants are useful as well, even though there is no evidence of depression and there is no risk of addiction with this medication.

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