Anxiety, Fears, and Phobias

What Are Anxiety Disorders?

Anxiety disorders produce symptoms of fear that are felt at times when nothing alarming is happening. Anxiety disorders can produce physical symptoms such as heart palpitations, dizziness, or digestive problems.

Most people have an exaggerated fear of something such as heights, performing in public, or small creatures. In most cases, people can live a happy life in spite of these fears. But for millions of people, the problem is severe enough to cause them suffering – or to restrict their activity.

Anxiety disorders include:

• Panic disorder, involving frequent or severe panic attacks.
• Agoraphobia, the fear of public places, which often accompanies panic disorder.
• Specific phobias, such as fear of small animals, heights, or enclosed spaces.
• Social phobia, which involves fear of embarrassment or humiliation in social situations.
• Post traumatic stress disorder
• Obsessive-compulsive disorder
• Generalized anxiety disorder

Fear itself is normal. And it has always been useful, helping people to survive. When cavemen came face to face with a wolf or a bear, it was fear that put them into top gear. It prepared them for “fight or flight,” giving them the strength to run or to do battle.

When you are afraid:

• You breathe harder and faster to give your body more oxygen.
• Your heart pumps faster to deliver extra oxygen to the muscles and brain.
• Your blood vessels adjust to direct blood to the parts of the body that need it.

In these ways, fear can give you the extra strength to save yourself from a runaway truck, or a mugger, or a burning building.

It is normal to feel the effects of fear sometimes, even when you are not in danger. For example, your heart might beat faster when you have to give a speech, meet the future in-laws, or close a deal.

But millions of Americans have symptoms of fear at times when nothing alarming is happening.

• Some have panic attacks that may seem to come out of the blue.
• Others suffer from phobias – extreme fear of things or situations that most people don’t find frightening.

Almost everyone with an anxiety disorder can be treated successfully. In the simplest cases, the “cure” may take only one session. Most courses of treatment are longer, but they are more likely to be measured in weeks rather than in months.

Panic Disorder

People with panic disorder have panic attacks, which can be devastating. Symptoms of a panic attack include frightening thoughts such as fear and dread, along with physical sensations such as heart palpitations and dizziness.

Panic attacks can come on suddenly. They usually reach their peak in about 10 minutes and are over in 20 minutes or less. However, in some cases, they may last as long as an hour.

If people have a panic attack in a specific situation, (for example, in a shopping mall) they may expect that panic will strike again the next time they are in that situation. As a result, they are likely to start avoiding that situation. When that happens, their condition is known as panic disorder with avoidance.

In severe cases, this pattern of avoidance is likely to develop into agoraphobia, the avoidance of open spaces and public areas. This is closely linked to panic disorder.

In some cases, however, panic attacks occur in no particular pattern. Avoiding specific situations doesn’t help. That condition is called simple panic disorder.

How Panic Builds Up

Often fear of panic is as disabling as the panic attacks themselves. Or the fear itself can provoke attacks:

• You experience a physical sensation, thought, or feeling that is threatening.
• These threatening sensations, thoughts, or feelings lead to physical symptoms, such as rapid heartbeat, shortness of breath, etc.
• The physical symptoms can make you feel even more frightened.
• This can lead to greater fear that something terrible is going to happen to you.

However, the cycle can be broken.

The first panic attacks you experience can be terrifying because you don’t know what is going on. But after you learn about panic, you will have one great advantage when an attack hits – you will understand what you are experiencing.

You will know that:

• You are not going to have a heart attack.
• You are not going to have a stroke.
• You are not going to collapse or die. It’s “only” panic, and it will go away soon.

Once you recognize that your symptoms are caused by panic, those symptoms may immediately become less severe. And your level of fear will go down.

Working With A Therapist

In recent years, psychiatrists, psychologists, and others have developed excellent methods of dealing with panic. In fact, the great majority of people with panic can be treated successfully. They usually can return to a life free from fear, without having to take medication for long periods.

For some, however, panic is a chronic condition and may come back. But if you have learned to cope with it once, it is usually easier to deal with if it returns.

To overcome panic and phobia, it is important for both you and the therapist to understand how the condition started and how it affects you.

Among other things, the therapist will need to know:

• When you first had a panic attack, and how it felt.
• What makes you afraid now, and what situations (if any) you now avoid, as a result of this fear.
• What physical symptoms you feel when you are afraid, or what symptoms you are afraid of feeling.
• How your fears are affecting your social life, your career, your happiness, or your ability to carry out the daily routine.

There is a basic strategy that many therapists follow. They will aim to:

• Reduce the frequency of you panic attacks with behavior therapy, relaxation, and medication.
• Encourage personal wellness, advising you to get more sleep and exercise, less caffeine.
• Help you develop coping skills. These may include learning to change how you think about panic, and learning to feel in control of panic attacks.

The therapist may ask you to:

• Keep a diary so that you know when panic is most likely to occur. A panic attack that you expect is easier to take than one that hits out of the blue.
• Plan how you will copy with panic attacks.
• Learn to feel in control of the symptoms of panic. For example, if you deliberately speed up your heart by running in place, you may feel less threatened if your heart races during a panic attack.

Your therapist may remind you that there are two ways of “coping” that do not work:

• Don’t take alcohol or drugs to give yourself the courage to face difficult situations.
• Don’t simply avoid all the situations that might bring on panic.

Medication For Panic Disorder

Psychiatrists and other physicians may prescribe medicine as part of the treatment.

Medication can help speed the course of treatment. It can usually be stopped before the counseling sessions are over. But in some cases, drugs may be needed for a longer time to treat underlying conditions, such as depression, that may have been covered up by the panic disorder. Different types of medication may be used.

Antidepressants help patients with panic disorder even if they aren’t depressed. Three different types may be helpful if taken regularly (not just as needed):

• SSRIs (selective serotonin reuptake inhibitors), such as fluoxetine, paroxetine, sertraline
• Tricyclics, such as imipramine, desipramine
• MAOIs (which inhibit a brain chemical called monoamine oxidase), such as phenelzine, tranylcypromine
• Benzodiazepines (a type of tranquilizer), such as alprazolam or clonazepam. (They may be addictive and must be used with care.)

Other medications may help:

• Buspirone is a non-habit-forming medication to reduce anxiety. It usually takes a few weeks to be effective.
• Beta-blockers may be used to reduce some effects of anxiety – for example, slowing a racing heart.

Panic Disorder With Agoraphobia

In some cases, panic disorder is linked to agoraphobia, the fear and avoidance of public places. The problem may start when a person has a panic attack in a certain place, or type of place. He or she may then become afraid of going to that place again in case the panic returns.

People who have panic disorder often develop fear of one or more of these situations:

• Going out alone
• Going in stores
• Eating in restaurants
• Using public transportation
• Being far from home
• Going to crowded places, like theaters and stadiums
• Waiting in lines
• Being in wide-open spaces

In recent years, therapists have developed successful methods of treatment involving exposure therapy. This type of therapy involves gradually getting the person used to a situation in order to overcome the fear it provokes. Some situations require only a few sessions of treatment. In other cases, treatment may take several weeks, or even months.

Exposure Therapy

Exposure therapy involves being exposed to the situation we are afraid of. That may sound alarming. But it is done gradually, so people need not feel threatened.

Exposure therapy helps get our natural defense system working the way it should.

When we are first in a dangerous situation, our senses are all keyed-up as we look for signals in our environment that mean something terrible is about to happen. This state is called hypervigilance.

If nothing terrible happens, most people experience less hypervigilance the next time, and even less the next. But people with panic disorder remain extra-sensitive.

Exposure therapy helps you get used to the fear-producing situation under controlled conditions. Once you are used to it, you may no longer respond as if it is a brand-new threat.

Therapists may use different approaches to the process of exposing you to your fears – or their source. Here’s one example of how exposure therapy can work:

• Laura panics in supermarkets. She and her therapist set up a schedule of gradual exposure.
• Twice a day, Laura went into the market when it wasn’t crowded. She spent three minutes there, and left without buying anything.
• Laura continued going in the store twice a day, still choosing a time when it wasn’t crowded. Each time when bought two items and picked a checkout line with only one person ahead of her.
• As she became more comfortable, she bought more items and picked longer lines.
• Laura was told that she must do the allotted task, even if her level of anxiety was high. She knew she could expect some feelings of panic, but was told to let those feelings “peak and pass.”
• It was up to her to decide when she was ready to move from one step to the next.

How Long Does Treatment Take?

In some cases, a course of gradual exposure to a situation may work quite fast. In others, treatment of agoraphobia may require months of regular exposure therapy and counseling.

In addition, it is quite common to have setbacks. After you think that you are better, you may start to feel fearful again. A “relapse” is especially likely to happen if you are under stress.

It is important not to let these setbacks get you down. They are quite common, and they don’t mean that you have failed in your course of treatment. You will have learned good techniques for dealing with your panic, so you will know how to help it go away.

Specific Phobias

Millions of people have a specific phobia. Unlike agoraphobia, which may be a fear of many situations, specific phobias are defined as a fear of one living thing, object or situation.

Among the most common phobias are fear of:

• Spiders, insects
• Flying
• Enclosed spaces (claustrophobia)
• Sex
• Snakes, dogs, cats
• Blood, injury, medical and dental procedures
• Heights (acrophobia)
• Driving

To others, certain types of phobia may seem quite trivial and even funny. But to those who have them, phobias are not funny at all. Indeed, they can often be quite limiting in their effects.

• A fear of snakes may be so strong that people cannot hike in the country.
• A fear of elevators or of flying may be crippling to business people who need to attend meetings on the 20th floor or fly to other cities.
• A fear of injections may keep people from important medical or dental treatment.

The good news is that these specific phobias are usually very easy to treat.

One of the symptoms of a specific phobia is avoidance. For example:

• People who are afraid of elevators may get around the problem by always booking hotel rooms on the lower floors so they can take the stairs.
• People who are afraid of blood may avoid visiting friends in the hospital.

Sometimes, people can’t avoid the object or situation they are afraid of. And if they must come face to face with it, they may have symptoms similar to those experienced during panic attacks:

• Tense muscles
• Heart palpitations
• Anxiety
• Shortness of breath

In some cases, phobias may produce panic. Then, symptoms may include:

• Dizziness
• Fear of going crazy
• Feelings of unreality
• Fear of dying

There’s nothing unusual about being nervous around barking dogs, or insects. But people who are truly phobic are afraid even when there is no threat. Some people with a spider phobia break out in hives when shown pictures of spiders.

How Do Specific Phobias Start?

Certain fears are a normal part of human development. For example, preschool children usually go through a period of being afraid of small animals. But in some people, these fears last into adulthood. In other cases:

• A dramatic event (like being stuck in a subway) may mark the beginning of a phobia.
• A fear may be learned. When one member of the family becomes phobic, others may develop the same fear.
• A mild phobia may become more severe as a result of illness or pregnancy.

Most often, however, there is no apparent reason for the beginning of a specific phobia.

You should consider therapy if you are suffering a great deal from your phobia. For example:

• Your circumstances may have changed so that you must now face the object or situation you are afraid of more frequently that before. For example, someone who is afraid of flying may have a promotion that requires more air travel.
• The phobia may be starting to dominate your thoughts and dreams.

Different therapists take different approaches. But treatment usually involves exposure therapy to help people get used to the object or situation that causes their fear.

Medication is usually not needed for specific phobias, though the doctor may prescribe it for use on special occasions.

• For example, people who are afraid of flying may be helped by a tranquilizer to keep them calm for a few hours. If they don’t fly often, this may be all the treatment they need.
• In some cases, the therapist may find that a person has more than a simple, specific phobia. For example, a sex phobia may be part of a more complex social phobia. Or a driving phobia may be a sign of agoraphobia – the fear of public places.

Sometimes, a course of treatment for a specific phobia can be extremely short. For example, it may be possible to overcome the fear of spiders through exposure therapy in less than one hour – like this:

• Looking at small, black and white pictures of spiders.
• Seeing larger pictures of spiders, some of them quite big and hairy.
• Seeing color pictures of large tropical spiders.
• Seeing a dead spider in a jar.
• Holding the dead spider.
• Holding a jar with a live spider.
• Watching a live spider released a few feet away.
• Touching the live spider

Although exposure treatment of other phobias may require more time and may be spread over several sessions, the principles are the same. This type of treatment has a very high rate of success.

Social Phobia

In recent years, mental health specialists have been paying more attention to social phobia.

In its mildest form, social phobia – fear of certain social situations – is not much worse that feeling shy. But for millions of people, this type of phobia can make contact with other people extremely difficult or even impossible.

People with social phobia are usually afraid of behaving in a way that is humiliating or embarrassing.

• They may convince themselves that everyone will notice their signs of unease, such as trembling or blushing.
• They may imagine that people are talking about them or laughing at them behind their back because of their lack of social skills, or their appearance.
• They may be afraid of losing control in public. For instance, they imagine they might vomit, or have problems with bowels or urination.
• They may find it extremely difficult to do things that are normally considered routine, such as eating or drinking in public, writing in public, or using public restrooms.

Compared to people who are simply shy, people with social phobia may experience more physical symptoms, such as:

• Blushing
• Dry mouth and throat
• Sweating
• Heart palpitations
• Tense muscles
• Trembling
• Sinking feeling in stomach
• Feeling hot or cold

In addition, some will feel other symptoms such as headache, lump in the throat, dizziness, an urgent need to use the toilet, or weakness or twitching in the muscles.

In many cases, people manage to adjust their lives in order to avoid the situations that give them trouble, and they get along fine. In other cases, people with social phobia lead lives that are quite restricted.

• Some avoid interaction with everyone outside their immediate families.
• Some can’t make progress professionally, because a better job would bring social demands they feel they could not meet.
• Some drop out of school or quit work.
• Many abuse alcohol or other drugs as they try to overcome their fears.

Treatment For Social Phobia

Social phobia is not always easy to treat. It may require a series of sessions with a psychiatrist, psychologist or other type of counselor. There are a number of approaches to treatment, and your therapist may suggest using one or more.

• Medication. As with other severe phobias or panic attacks, the doctor may prescribe medication. This may be given for just a short time, as people learn ways to get comfortable in situations that have been difficult.
• Exposure Therapy. Starting with situations that are not too threatening, a therapist might arrange for you to practice surviving social encounters. Sometimes, a friend, relative, or other trusted person might be asked to observe what actually happens. For example, a social phobic may be convinced that everyone in the room will stare at a trembling hand. The observer can report that this doesn’t happen.

  In some cases, people are instructed to make their hands shake or their voices tremble deliberately in situations where they are afraid of seeming nervous. This gives them a sense of control over the situation. And it shows that even when they seem really uneasy, people don’t react strongly.

Anxiety, Fears, and Phobias: Where To Find Help

If you have an anxiety disorder, such as panic disorder or phobia, don’t suffer in silence or wait to “grow out of it.”

Too many people may hold back from treatment because they are afraid that only those who are mentally ill go to mental health professionals, and they don’t want to apply that label to themselves. Or perhaps they doubt whether the treatment will be effective.

But people with anxiety disorders are not mentally ill. And most people with panic, fears, and phobias can be successfully treated.

Your primary care provider may have been trained to deal with certain anxiety disorders. He or she may refer you to a therapist who has the appropriate training.

• Psychiatrists are medical doctors who can prescribe medication if needed. They also provide counseling and behavioral treatment.
• Psychologists may also give counseling and behavioral treatment for anxiety disorders. They cannot prescribe medication, but may work closely with your primary physician if medicine is needed.
• Other counselors may be trained to provide treatment, especially for the simpler conditions, such as specific phobias. These professionals include social workers, marriage and family counselors, and others.

It is very important to choose a therapist you can trust and feel at ease with.

You will need to describe your feelings, fears and experiences very openly, even if it is embarrassing for you to do so.

The therapist may also ask you to do things that may seem difficult or embarrassing. This type of challenge may be what you need to overcome your fears, but it may not be easy.

Some patients are reluctant to see a mental health professional because they are afraid it means they are “crazy.” But they needn’t worry.

• There is nothing “crazy” about having fears and phobias.
• Millions of people who are sane and well adjusted suffer from anxiety disorders – and overcome them.

Group therapy also may be an option. In some cases, working with a group of other people with a similar problem can be helpful.

There are two main advantages to group therapy:

• People offer each other support
• Group therapy generally is less expensive than individual counseling

Frequently Asked Questions: Anxiety, Fears, and Phobias

Here are some frequently asked questions related to anxiety, fears, and phobias.

Q: Are there different types of anxiety?

A: Yes. Anxiety can be a general feeling of worry, a sudden attack of panicky feelings, a fear of a certain situation or a response to a traumatic experience.

Q: One day when I was driving home from work I had apanic attack. Now I’m reluctant to drive. Is this going to go away on its own?

A: What you experienced is a classic panic attack, which can come seemingly out of the blue. Now you are experiencing avoidance by being reluctant to get behind the wheel again. You can’t will away your panic attack. Instead of suffering alone, seek treatment from a professional who has experience in treating these disorders. Don’t let embarrassment stop you from returning to an active lifestyle.

Q: A close friend has just been diagnosed with a phobia. What can I do to help?

A: Support from family and friends is an important part of recovery process but ultimately the person who is suffering from the phobia will have to do most of the work. However, you can lend support by learning about the disorder, being flexible, praise small steps forward and be realistic in your expectations. Your patience will be of great help.

Q: Once before I was treated for an anxiety disorder and now I’ve been having the same feelings again. Can it be treated again?

A: When you undergo treatment for an anxiety disorder, you and your doctor or therapist work together as a team to find the best approach to treat your anxiety. That will include a detailed history of your previous treatment, as well as overall health. When treatment begins, some people feel much better after a single session while others require weeks of care. Most people are treated with therapy of some sorts while others benefit from medication. If one treatment doesn’t work, the odds are good that another one will. Don’t give up hope.

Putting It All Together: Anxiety, Fears, and Phobias

Here is a summary of the important facts and information related to anxiety, fears, and phobias.

• Fear is normal and useful, but millions of people suffer inappropriate fear in the form of phobias or panic attacks.
• In some cases, fears and anxiety may produce physical symptoms.
• Fears can be treated by a mental health professional, such as a psychiatrist, a psychologist, or a counselor with a special training in the field.
• Panic may strike out of the blue for no apparent reason, bringing physical symptoms such a heart palpitations or digestive disturbances as well as feelings of dread, terror and impending death.
• Agoraphobia involves fear of the world outside, usually follows panic attacks, and can interfere seriously with people’s lives.
• Specific phobias involve fear of one type of small creature, such as spiders, dogs, or cats, or of one type of situation, such a flying, looking down from heights, or being in enclosed spaces.
• Social phobia involves an exaggerated fear of embarrassment and humiliation.

Glossary: Anxiety, Fears, and Phobias

Here are definitions of medical terms related to anxiety, fears, and phobias.

Agoraphobia: Fear of going into open spaces, or public areas.

Counselor: A mental health professional, such as a social worker, marriage and family counselor, or psychiatric nurse clinician who can give counseling and therapy to change behavior.

Generalized anxiety disorder: People experience a constant state of anxiety and worry about things in their daily lives. This state lasts at least six months and can be accompanied by physical symptoms, such as muscle tension, headache, nausea and fatigue.

Obsessive-compulsive disorder: People experience unwanted thoughts or compulsive behaviors that they feel they cannot stop or control.

Panic attack: Unexpected feelings of fear, often accompanied by physical symptoms that come on suddenly, increase rapidly in intensity, and last 20 minutes or more.

Panic disorder: A type of anxiety disorder characterized by repeated panic attacks that are not caused by an actual threat or danger.

Panic disorder with avoidance: A condition in which people avoid situations that they fear will produce panic attacks.

Post traumatic stress disorder: People who experience or see a traumatic event – such as war, an accident, or a crime – may experience flashbacks and nightmares, along with depression, anger and sleep problems.

Psychiatrist: A medical doctor who can prescribe medication in addition to giving counseling and behavior therapy.

Psychologist: A mental health professional with a doctorate in psychology who can give counseling and behavioral therapy, but cannot prescribe medication.

Specific phobia: A persistent fear of, and desire to avoid, a certain object or situation.

Social phobia: An exaggerated fear of embarrassment or humiliation.

Additional Sources Of Information: Anxiety, Fears, and Phobias

Here are some reliable sources that can provide more information on anxiety, fears, and phobias.

American Psychological Association

http://helping.apa.org

Freedom From Fear

http://www.freedomfromfear.org/

Anxiety In Children Available at KidsHealth.org

http://kidshealth.org/parent/emotions/feelings/anxiety.html