Anxiety

  Anxiety is fear spread thin. We’ve all experienced it and undoubtedly it is useful – a degree of anxiety is essential to keep us alert and get us to perform well – e.g. fear of failure gets us to work hard for exams. However psychological studies show that, while performance rises with anxiety up to a point, above a certain level our performance plummets. Anxiety disorders are probably about as common as depression but fewer people seek help for them. People with ‘Generalized Anxiety Disorder’ (GAD) are persistently over-anxious. Most of us experience similar anxiety levels from time to time, but in anxiety disorders it doesn’t settle. GAD is exhausting and sufferers can’t sleep, lose weight, and often can’t concentrate. If it goes on a long time they may become depressed.

  Phobic disorders are more dramatic and noticeable. A phobia means an exaggerated fear. Most of us have a phobia – so-called simple phobias start in childhood and are constant through life. Animal phobias are typical examples (spiders, mice, snakes). Mine is a height phobia – I can’t climb towers or go near cliff edges. Most people live with their simple phobias unless they begin to interfere seriously with life (e.g. a flying phobia in someone whose job begins to require frequent travel, a needle phobia in a woman who becomes pregnant and needs to have blood tests). Simple phobias are remarkably easy to cure by behaviour therapy using ‘graded exposure’. You get used to the feared object by following a preset scheme increasing the exposure while monitoring your own anxiety (e.g. start with holding a picture of a spider then hold a small dead one, a larger dead one, a living one in a glass, a living one free, and then a tarantula!).

  Most of the phobias seen by psychiatrists are not simple phobias. They are either agoraphobia or social phobia. These start in adult life, are not constant (they are worse in times of stress), and can be quite disabling. Agoraphobia is not fear of open spaces as many think, but of crowds and crowded places. It comes from the Greek word Agoros for market place, not the Latin word Ager for field. Agoraphobia affects women much more and is associated with panic attacks and often leads to staying in and avoiding crowds. It is this ‘avoidance’ that makes the disorder continue. Panic attacks are awful (racing heart, sweating, a dry mouth, and conviction that one is going to faint, wet oneself, or even die). It is no surprise that people exit the situation as fast as possible and avoid it. The pity is that if they stayed they would soon realize that panic is very short-lived (a matter of minutes, not hours) and fades on its own. However when we rush off and the panic stops we become convinced that it was the getting away that stopped it and we don’t learn that we can ride out the panic. The memory of the last panic starts to get us anxious as we approach the situation again and this ‘fear of the fear’ increases the likelihood of another attack.

  Treatment is usually based on behaviour therapy, teaching the person how to stay with a panic attack and thereby reduce it. It is usually a bit more complicated than with simple phobias. Social phobia is an exaggerated anxiety on meeting people. There is some real controversy about whether this is a legitimate diagnosis or simply severe shyness, and particularly whether it should be treated with drugs (Chapter 6). In social phobia the problem is usually one of avoidance rather than panic and the treatment involves counselling to help develop techniques for dealing with social situations.