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. Burn out 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 work place. 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               * choking sensations 

• and depression                    * hyperventilation where we 

• irritability                               have short shallow breathing 

• hostility                                 * churning in the stomach 

• marked feelings of                * nausea 

• frustration                             * vomiting 

• disturbed sleep pattern         * nervous diarrhoea 

• agitation                                 * frequency of passing urine 

• talking too quickly and           * weakness at the knees 

• loudly                                     * hand tremor 

• sweating                                * pins and needles sensations        

• dizziness                                • tension headaches           

• 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. 

Agoraphobiawhich 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.

Profile of the author

Dr Adrian Winbow is a Consultant Psychiatrist and has been in independent private psychiatric practice since 1986. He runs out-patient clinics in London, Croydon, Brentwood, Orpington, Sevenoaks and Tunbridge Wells. 

 He is a fellow of the Royal College of Psychiatrists and holds a Diploma in Psychological Medicine. He has worked as a Consultant Psychiatrist in the South East initially in the National Health Service since 1978 and still sees a variety of out patients in private medical/surgical hospitals every day as well as having in patients and day patients  His special interests include depressive illness, alcohol misuse, chronic fatigue syndromes and also eating disorders. His approach to psychiatric treatment is fairly eclectic and includes the use of psychotropic medication as well as psychotherapy and cognitive behavioural therapy, relaxation techniques, anxiety management and hypnotherapy.

View more information about Dr Winbow - http://www.privatepsychiatry.co.uk/Home.html

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