Anxiety, Panic and Phobias Introduction Anxiety is a feeling we all get in a situation that is threatening or difficult. The anxiety stops when you get used to the situation, when the situation changes, or if you just leave.
But if you feel anxious all the time, or for no obvious reason, it can make life difficult.
This leaflet deals with three particular kinds of anxiety:
- general anxiety disorder
- panic attacks
What is anxiety? Anxiety feels like fear. When it's there a lot of the time, caused by a problem in our life that can't be solved, like money difficulties, we call it worry. If is a sudden reaction to a threat, like looking over a cliff or being confronted by an angry dog, we call it fear.
Although worry, fear and anxiety are unpleasant, they can all be helpful:
- psychologically - they keep us alert and give us the 'get up and go' to deal with problems
- physically - they make our body ready for action - to run away from danger or to attack it - the 'fight or flight' response.
Isn't anxiety just 'stress'? In English, 'stress' can mean two different things:
- the things that make us anxious - "my work is stressful"
- our anxious reaction to them - "I feel really stressed out".
Isn't anxiety/stress bad for you? Some anxiety is good for you. It keeps you alert and can help you to perform well. But only some. If it gets too intense, or goes on for too long, it can make you feel bad and interfere with your life. It can make you depressed and damage your physical health.
What does anxiety feel like? In the mind In the body
- Feeling worried all the time
- Fast or irregular heartbeats (palpitations)
- Feeling tired
- Unable to concentrate
- Face goes pale
- Feeling irritable
- Dry mouth
- Sleeping badly
- Muscle tension and pains
- Feeling depressed
- Numbness or tingling in fingers, toes or lips
- Breathing fast
- Passing water frequently
- Nausea, stomach cramps
Anxiety seems to take three main forms, but they overlap and most people will probably experience more than one type.
- Generalised anxiety disorder (GAD)
- Panic attacks
- that you are going to die
- frightened or 'going crazy' or losing control
- short of breath and that you are choking.
Common phobias include:
- agoraphobia - a fear of going where there are other people - which can stop you from leaving the house
- social phobias - a fear of being with other people - which can make it hard to talk to other people.
What causes these kinds of anxiety?
It can also happen:
- if you have been neglected or abused in childhood
- if you have been abused, persistently mistreated or tortured as an adult.
- Mental health problems
- Physical problems
- Some or all the above ...
Getting help Anxiety is very common and many of us overcome it or cope with it without professional help. However, if it is severe or goes on for a long time, anxiety can affect your physical health, and stop you doing the things you want to do. The good news is that there are ways to help yourself.
- Talk about it. This can help when the anxiety comes from recent knocks, like a partner leaving, a child becoming ill or losing a job. Who should you talk to? Try a friend or relative who you trust and respect, and who is a good listener. They may have had the same problem themselves, or know someone else who has.
- Self-help groups. These are a good way of getting in touch with people who have similar problems. They can understand what you are going through. As well as having the chance to talk, you may be able to find out how other people have coped. Some of these groups are specifically about anxieties and phobias. Others may be for people who have been through similar experiences - women's groups, bereaved parents' groups, survivors of abuse.
- Learning to relax. It sounds too obvious - surely everyone can relax? But if your anxiety just won't go away, it can be really helpful to learn some special ways of relaxing, to be a bit more in control of your anxiety and tension. You can learn these through groups, with professionals, but there are several books and self-help materials you can use to teach yourself. It's a good idea to practice relaxation regularly, not just at times of crisis.
- Using a self-help book. This works well for many people. Most of the books use the principles of Cognitive Behavioural Therapy (CBT) - see below.
Getting help If you have an anxiety problem which just won't go away, you may not ask for help because you worry that people might think that you are "mad". They won't. It's a common problems and it's much better to get help rather than suffer in silence.
- Cognitive Behavioural Therapy (CBT)
- Computerised CBT
If this is not enough, there are several different kinds of professionals who may be able to help - the GP, psychiatrist, psychologist, social worker, nurse or counsellor. Psychotherapists may or may not be medically qualified.
- They should not be used for longer-term treatment of anxiety.
- They should not be used at all in panic disorder.
Beta-blockers in low doses can sometimes control the physical shaking of anxiety. They can be taken shortly before meeting people or before speaking in public, or having to perform.
- Herbal remedies
Which treatments work best? The treatments that seem to work for the longest time are, in descending order
- psychological therapy (CBT)
- pharmacological therapy (an SSRI)
- self-help (books based on CBT principles).
Many children are scared of the dark or of imaginary monsters. These fears usually disappear as the child grows older, but they do not usually spoil the child's life or interfere with their development. Most will feel anxious about important events like their first day at school. Once it is over, the child stops being frightened and is able to get on and enjoy the new situation.
Teenagers often feel anxious. They tend to be worried about how they look, what other people think of them, how they get on with people in general, but especially about forming close relationships. These worries can usually be helped by talking about them. However, if they are too strong, other people may notice that they are doing badly at school, behaving differently, or feeling physically unwell.
If a child or teenager feels so anxious or fearful that it is spoiling their life, it's a good thing to ask your GP for advice.
Self-help organisations Anxiety UK: Helpline: 08444 775 774. Charity formed 30 years ago by a sufferer of agoraphobia for those affected by anxiety disorders.
British Association for Behavioural and Cognitive Psychotherapies (BABCP)
Has a UK register of accredited therapists.
No Panic: Helpline: 0800 138 8889. National Organisation for Phobias , Anxiety, Neurosis, Information and Care. Support for sufferers of Panic Attacks, Phobias, Obsessive Compulsive Disorder, Generalised Anxiety Disorder and Tranquilliser Withdrawal.
- Overcoming Anxiety by Helen Kennerley, Constable & Robinson
- Overcoming Anxiety, Stress and Panic: A Five Areas Approach by Chris Williams, CRC Press
- Feel the Fear and Do It Anyway by Susan Jeffers, Vermilion
- Overcoming Panic and Agoraphobia by Derrick Silove and Vijaya Manicavasagar, Constable & Robinson
- Panic Attacks: What They Are, Why They Happen and What You Can Do About Them by Christine Ingram, HarperCollins
- An Introduction to Coping with Phobias by Brenda Hogan, Constable & Robinson.
- Living Life to the Full: Free online life skills course for people feeling distressed and their carers. Helps you understand why you feel as you do and make changes in your thinking, activities, sleep and relationships.
- FearFighter: (free access can only be prescribed by your doctor in England and Wales)
- Barr Taylor, C. (2006) Panic disorder. BMJ: 332: 951-955.
- Cohen, A. (2008) The primary care management of anxiety and depression: a GP’s perspective. Advances in Psychiatric Treatment, 14: 98-105.
- Ernst, E. (2007) Herbal remedies for depression and anxiety. Advances in Psychiatric Treatment, 13, 312–316.
- NICE (January 2011) Generalised anxiety disorder and panic disorder (with or without agoraphobia): Management in primary, secondary and community care: Quick Reference Guide.
- NICE (2008) Computerised cognitive behaviour therapy for depression and anxiety. Review of Technology Appraisal 51. National Institute for Health and Clinical Excellence: London.
- Sareen, J. et al (2006) Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Archives of Internal Medicine, 166, 2109–2116.
- Scott, A., Davidson, A. & Palmer, K. (2001) Antidepressant drugs in the treatment of anxiety disorders. Advances in Psychiatric Treatment, 7, 275–282.