Dr Caitlin: Phobic Anxiety Disorders

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Dr Caitlin O’Connor of Tralee Medical Centre in St Brendan’s Park on phobic anxiety disorders…

A phobia is strong fear or dread of a thing or event. The fear is out of proportion to the reality of the situation. Coming near or into contact with the feared situation causes anxiety.

Sometimes even thinking of the feared situation causes anxiety. Therefore, you end up avoiding the feared situation, which can restrict your life and may cause suffering.

Social anxiety disorder

Social anxiety disorder (also known as social phobia) is possibly the most common phobia. With social anxiety disorder you become very anxious about what other people may think of you, or how they may judge you.

Therefore, you fear meeting people, or ‘performing’ in front of other people, especially strangers. You fear that you will act in an embarrassing way and that other people will think that you are stupid, inadequate, weak, foolish, crazy, etc. You avoid such situations as much as possible. If you go to the feared situation you become very anxious and distressed.

Agoraphobia

This too is common. Many people think that agoraphobia means a fear of public places and open spaces. But this is just part of it. If you have agoraphobia you tend to have a number of fears of various places and situations. So, for example, you may have a fear of:

• Entering shops, crowds, and public places.

• Travelling in trains, buses, or planes.

• Being on a bridge or in a lift.

• Being in a cinema, restaurant, etc, where there is no easy exit.

But they all stem from one underlying fear. That is, a fear of being in a place where help will not be available, or where you feel it may be difficult to escape to a safe place (usually to your home).

When you are in a feared place you become very anxious and distressed and have an intense desire to get out. To avoid this anxiety many people with agoraphobia stay inside their home for most or all of the time.  Other specific phobias…

There are many other phobias of a specific thing or situation. For example:

• Fear of confined spaces or of being trapped (claustrophobia).

• Fear of certain animals.

• Fear of injections.

• Fear of being sick (vomiting).

• Fear of being alone.

• Fear of choking.

But there are many more…

Panic disorder

Panic disorder means that you have recurring panic attacks. A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning and for no apparent reason. The physical symptoms of anxiety during a panic attack can be severe and include:

• The sensation of having a ‘thumping heart’ (palpitations).

• Trembling.

• Feeling short of breath.

• Chest pains.

• Feeling faint.

• Numbness.

• Pins and needles.

Each panic attack usually lasts 5-10 minutes but sometimes they come in waves for up to two hours.

Anxiety treatment – for disorders and phobias

The main aim of anxiety treatment is to help you to reduce symptoms so that anxiety no longer affects your day-to-day life.

The treatment options depend on what condition you have and how severely you are affected. They may include one or more of the following:

NON-MEDICATION TREATMENTS

Understanding

Understanding the cause of symptoms and talking things over with a friend, family member or health professional may help.

In particular, some people worry that the physical symptoms of anxiety, such as a ‘thumping heart’ (palpitations), are due to a physical illness.

This can make anxiety worse. Understanding that you have an anxiety disorder is unlikely to cure it but it often helps.

Counselling

This may help some people with certain conditions. For example, counselling which focuses on problem-solving skills may help if you have GAD.

Anxiety management courses

These may be an option for some conditions, if courses are available in your area. The courses may include: learning how to relax, problem-solving skills, coping strategies, and group support.

Cognitive and behavioural therapy (CBT)

These therapies, if available in your area, can work well for persisting anxiety disorders and phobias:

Cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as anxiety and depression.

The therapist helps you to understand your current thought patterns – in particular, to identify any harmful, unhelpful and false ideas or thoughts which you have that can make you anxious (or depressed).

The aim is then to change your ways of thinking to avoid these ideas; also, to help your thought patterns to be more realistic and helpful. Therapy is usually done in weekly sessions of about 50 minutes each, for several weeks.

You have to take an active part and are given homework between sessions. For example, you may be asked to keep a diary of your thoughts which occur when you become anxious or develop physical symptoms of anxiety.

Behavioural therapy aims to change any behaviours which are harmful or not helpful. For example, with phobias your behaviour or response to the feared object is harmful and the therapist aims to help you to change this.

Various techniques are used, depending on the condition and circumstances. As with cognitive therapy, several sessions are needed for a course of therapy.

CBT is a mixture of the two where you may benefit from changing both thoughts and behaviours. (Note: cognitive and behavioural therapies do not look into the events of the past. They deal with, and aim to change, your current thought processes and/or behaviours.)

Self-help

There are various national groups which can help by giving information, advice and support (see below). They, or your doctor or practice nurse, may also be able to put you in touch with a local group for face-to-face support.

You can also get leaflets, books, CDs, DVDs, MP3s, etc, on relaxation and combating stress. They teach simple deep-breathing techniques and other measures to relieve stress, help you to relax, and possibly ease anxiety symptoms.

MEDICATION

Antidepressant medicines

These are commonly used to treat depression but also help to reduce the symptoms of anxiety even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing anxiety symptoms.

Antidepressants do not work straightaway. It takes 2-4 weeks before their effect builds up and the anxiety symptoms are helped.

A common problem is that some people stop the medicine after a week or so, as they feel that it is doing no good. This is often too soon to know if the medication will work.

Antidepressants are not tranquillisers and are not usually addictive.

There are several types of antidepressants, each with various pros and cons. They may differ in their possible side-effects.

However, selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used for anxiety disorders. Two examples of SSRIs are escitalopram and sertraline.

Note: after first starting an antidepressant, in some people the anxiety symptoms become worse for a few days before they start to improve.

Your doctor or practice nurse will want to keep a check on you in the first few weeks of treatment to see if you have any problems.

Benzodiazepines

Benzodiazepines such as diazepam used to be the most commonly prescribed anxiety treatment. They were known as the minor tranquilisers but they do have some serious known side-effects.

They often work well to ease symptoms. The problem is they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Now they are not used much for persistent anxiety conditions.

A short course of up to two weeks may be an option for anxiety which is very severe and short-term, or now and then to help you over a bad spell if you have persistent anxiety symptoms.

Buspirone

Buspirone is sometimes prescribed to treat GAD. It is an anti-anxiety medicine but different to the benzodiazepines and is not thought to be addictive. It is not clear how it works. It is thought to affect serotonin, a brain chemical which may be involved in causing anxiety symptoms.

Beta-blocker medicines

A beta-blocker – for example, propranolol – can ease some of the physical symptoms such as trembling and a ‘thumping heart’ (palpitations). Beta-blocker medicines do not directly affect the mental symptoms such as worry. However, some people relax more easily if their physical symptoms are eased. These tend to work best in short-lived (acute) anxiety. For example, if you become more anxious before performing in a concert then a beta-blocker may help to ease ‘the shakes’.

In some cases a combination of anxiety treatments such as cognitive therapy and an antidepressant may work better than either treatment alone.

Alcohol and anxiety

Although alcohol may ease symptoms in the short term, don’t be fooled that drinking helps to cure anxiety.

In the long run, it does not. Drinking alcohol to ‘calm nerves’ can lead to problem drinking and may make problems with anxiety and depression worse in the long term. See a doctor if you are drinking alcohol (or taking street drugs) to ease anxiety.

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