Anxiety Disorders and Anxiety Attacks
Recognizing the signs and symptoms, and getting help
Is a phobia keeping you from doing things you'd like to do? Learn how to recognize, treat, and overcome the problem.
Almost everyone has an irrational fear or two—of spiders, for example, or your annual dental checkup. For most people, these fears are minor. But when fears become so severe that they cause tremendous anxiety and interfere with your normal life, they’re called phobias.
A phobia is an intense fear of something that, in reality, poses little or no actual danger. Common phobias and fears include closed-in places, heights, highway driving, flying insects, snakes, and needles. However, you can develop phobias of virtually anything. While most phobias develop in childhood, they can also develop in later life.
If you have a phobia, you probably realize that your fear is irrational, yet you still can't control your feelings. Just thinking about the feared object or situation may make you anxious. And when you're actually exposed to the thing you fear, the terror is automatic and overwhelming. The experience is so nerve-wracking that you may go to great lengths to avoid it—inconveniencing yourself or even changing your lifestyle. If you have claustrophobia, for example, you might turn down a lucrative job offer if you have to ride the elevator to get to the office. If you have a fear of heights, you might drive an extra 20 miles in order to avoid a tall bridge.
Understanding your phobia is the first step to overcoming it. It's important to know that phobias are common. (Having a phobia doesn't mean you're crazy!) It also helps to know that phobias are highly treatable. No matter how out of control it feels right now, you can overcome your anxiety and fear and start living the life you want.
Barbara is terrified of flying. Unfortunately, she has to travel a lot for work, and this traveling takes a terrible toll. For weeks before every trip, she has a knot in her stomach and a feeling of anxiety that won't go away. On the day of the flight, she wakes up feeling like she's going to throw up. Once she's on the plane, her heart pounds, she feels lightheaded, and she starts to hyperventilate. It gets worse and worse with every flight.
Barbara's fear of flying has gotten so bad that she finally told her boss she can only travel to places within driving distance. Her boss was not happy about this, and Barbara's not sure what will happen at work. She's afraid she'll be demoted or lose her job altogether. But better that, she tells herself, than getting on a plane again.
It is normal and even helpful to experience fear in dangerous situations. Fear serves a protective purpose, activating the automatic “fight-or-flight” response. With our bodies and minds alert and ready for action, we are able to respond quickly and protect ourselves. But with phobias the threat is nonexistent or greatly exaggerated. For example, it is only natural to be afraid of a snarling Doberman, but it is irrational to be terrified of a friendly poodle on a leash, as you might be if you have a dog phobia.
|The difference between normal fear and a phobia|
|Feeling anxious when flying through turbulence or taking off during a storm||Not going to your best friend's island wedding because you'd have to fly there|
|Experiencing butterflies when peering down from the top of a skyscraper or climbing a tall ladder||Turning down a great job because it's on the 10th floor of the office building|
|Getting nervous when you see a pit bull or a Rottweiler||Steering clear of the park because you might see a dog|
|Feeling a little queasy when getting a shot or when your blood is being drawn||Avoiding necessary medical treatments or doctor's checkups because you're terrified of needles|
Many childhood fears are natural and tend to develop at specific ages. For example, many young children are afraid of the dark and may need a nightlight to sleep. That doesn't mean they have a phobia. In most cases, they will grow out of this fear as they get older.
For example, the following childhood fears are extremely common and considered normal:
0-2 years – Loud noises, strangers, separation from parents, large objects.
3-6 years – Imaginary things such as ghosts, monsters, the dark, sleeping alone, strange noises.
7-16 years – More realistic fears such as injury, illness, school performance, death, natural disasters.
If your child's fear is not interfering with their daily life or causing them a great deal of distress, then there's little cause for undue concern. However, if the fear is interfering with your child's social activities, school performance, or sleep, you may want to see a qualified child therapist.
There are four general types of phobias and fears:
Some phobias, however, don't fall into one of the four common categories. These include fear of choking, fear of getting a disease such as cancer, and fear of clowns. Other common phobias that don't fit neatly into any of the four categories include:
Social phobia, also called social anxiety disorder, is fear of social situations where you may be embarrassed or judged. If you have social phobia, then you may be excessively self-conscious and afraid of humiliating yourself in front of others. Your anxiety over how you will look and what others will think may lead you to avoid certain social situations you'd otherwise enjoy.
Fear of public speaking—an extremely common phobia—is a type of social phobia. Other fears associated with social phobia include fear of eating or drinking in public, talking to strangers, taking exams, mingling at a party, or being called on in class.
Agoraphobia was traditionally thought to involve a fear of public places and open spaces, but is now believed to develop as a complication of panic attacks.
If you're afraid of having another panic attack, you become anxious about being in situations where escape would be difficult or embarrassing. For example, you're likely to avoid crowded places such as shopping malls and movie theaters. You may also avoid cars, airplanes, subways, and other forms of travel. In more severe cases, you might only feel safe at home.
The symptoms of a phobia can range from mild feelings of apprehension and anxiety to a full-blown panic attack. Typically, the closer you are to the thing you're afraid of, the greater your fear will be. Your fear will also be higher if getting away is difficult.
The symptoms of blood-injection-injury phobia are slightly different from other phobias. When confronted with the sight of blood or a needle, you experience not only fear, but also disgust.
Like other phobias, you initially feel anxious as your heart speeds up. However, unlike other phobias, this acceleration is followed by a quick drop in blood pressure, which leads to nausea, dizziness, and fainting. Although a fear of fainting is common in all specific phobias, blood-injection-injury phobia is the only phobia where fainting can actually occur. Read: Overcoming a Fear of Needles.
Although phobias are common, they don't always cause considerable distress or significantly disrupt your life. For example, if you have a snake phobia, it may cause no problems in your everyday activities if you live in a city where you're not likely to run into one. On the other hand, if you have a severe phobia of crowded spaces, living in a big city would pose a problem.
If your phobia doesn't impact your life that much, it's probably nothing to be concerned about. But if avoidance of the object, activity, or situation that triggers your phobia interferes with your normal functioning, or keeps you from doing things you would otherwise enjoy, it's time to seek help.
Consider treatment for your phobia if:
Self-help strategies and therapy can both be effective at treating a phobia. What's best for you depends on factors such as the severity of your phobia, your access to professional therapy, and the amount of support you need.
As a general rule, self-help is always worth a try. The more you can do for yourself, the more in control you'll feel—which goes a long way when it comes to phobias and fears. However, if your phobia is so severe that it triggers panic attacks or uncontrollable anxiety, you may want to seek additional support.
Therapy for phobias has a great track record. Not only does it work extremely well, but you tend to see results very quickly—sometimes in as a little as one to four sessions. However, support doesn't have to come in the guise of a professional therapist. Just having someone to hold your hand or stand by your side as you face your fears can be extremely helpful.
It's only natural to want to avoid the thing or situation you fear. But when it comes to conquering phobias, facing your fears is the key. While avoidance may make you feel better in the short-term, it prevents you from learning that your phobia may not be as frightening or overwhelming as you think. You never get the chance to learn how to cope with your fears and experience control over the situation. As a result, the phobia becomes increasingly scarier and more daunting in your mind.
The most effective way to overcome a phobia is by gradually and repeatedly exposing yourself to what you fear in a safe and controlled way. During this exposure process, you'll learn to ride out the anxiety and fear until it inevitably passes. Through repeated experiences facing your fear, you'll begin to realize that the worst isn't going to happen; you're not going to die or “lose it.” With each exposure, you'll feel more confident and in control. The phobia begins to lose its power.
It's important to begin with a situation that you can handle, and work your way up from there, building your confidence and coping skills as you move up the “fear ladder.”
Make a list. Make a list of the frightening situations related to your phobia. If you're afraid of flying, your list (in addition to the obvious, such as taking a flight or getting through takeoff) might include booking your ticket, packing your suitcase, driving to the airport, watching planes take off and land, going through security, boarding the plane, and listening to the flight attendant present the safety instructions.
Build your fear ladder. Arrange the items on your list from the least scary to the most scary. The first step should make you slightly anxious, but not so frightened that you're too intimidated to try it. When creating the ladder, it can be helpful to think about your end goal (for example, to be able to be near dogs without panicking) and then break down the steps needed to reach that goal.
Work your way up the ladder. Start with the first step and don't move on until you start to feel more comfortable doing it. If possible, stay in the situation long enough for your anxiety to decrease. The longer you expose yourself to the thing you're afraid of, the more you'll get used to it and the less anxious you'll feel when you face it the next time. Once you've done a step on several separate occasions without feeling too much anxiety, you can move on to the next step. If a step is too hard, break it down into smaller steps or go slower.
Practice. The more often you practice, the quicker your progress will be. However, don't rush. Go at a pace that you can manage without feeling overwhelmed. And remember: you will feel uncomfortable and anxious as you face your fears, but the feelings are only temporary. If you stick with it, the anxiety will fade.
Step 1: Look at pictures of dogs.
Step 2: Watch a video with dogs in it.
Step 3: Look at a dog through a window.
Step 4: Stand across the street from a dog on a leash.
Step 5: Stand 10 feet away from a dog on a leash.
Step 6: Stand five feet away from a dog on a leash.
Step 7: Stand beside a dog on a leash.
Step 8: Pet a small dog that someone is holding.
Step 9: Pet a larger dog on a leash.
Step 10: Pet a larger dog off leash.
While it's natural to feel scared or anxious as you face your phobia, if you start to feel overwhelmed, immediately back off and use the techniques outlined below to quickly calm your nervous system.
When you're afraid or anxious, you experience a variety of uncomfortable physical symptoms, such as a racing heart and a suffocating feeling. These physical sensations can be frightening themselves—and a large part of what makes your phobia so distressing. However, by learning how to calm yourself down quickly, you can become more confident in your ability to tolerate uncomfortable sensations and face your fears.
Perform a simple deep breathing exercise. When you're anxious, you tend to take quick, shallow breaths (known as hyperventilating), which actually adds to the physical feelings of anxiety. By breathing deeply from the abdomen, you can reverse these physical sensations and feel less tense, less short of breath, and less anxious. Practice when you're feeling calm until you're familiar and comfortable with the exercise.
One of the quickest and most reliable ways to relieve anxiety is by engaging one or more of your senses—sight, sound, taste, smell, touch—or through movement. But since everyone is different, you'll need to do some experimenting to discover what works best for you.
Movement – Go for a walk, jump up and down, or gently stretch. Dancing, drumming, and running can be especially effective at relieving anxiety.
Sight – Look at anything that relaxes you or makes you smile: a beautiful view, family photos, cat pictures on the Internet.
Sound – Listen to soothing music, sing a favorite tune, or play a musical instrument. Or enjoy the relaxing sounds of nature (either live or recorded): ocean waves, wind through the trees, birds singing.
Smell – Light scented candles. Smell the flowers in a garden. Breathe in the clean, fresh air. Spritz on your favorite perfume.
Taste – Slowly eat a favorite treat, savoring each bite. Sip a cup of coffee or herbal tea. Chew on a stick of gum. Enjoy a mint or your favorite hard candy.
Touch – Give yourself a hand or neck massage. Cuddle a pet. Wrap yourself in a soft blanket. Sit outside in the cool breeze.
When fear or anxiety starts to carry you away, meditating can help stop it in its tracks. And with regular practice, meditation boosts activity in the area of the brain responsible for feelings of serenity, helping to quell fear and panic before they strike.
When you have a phobia, you tend to overestimate how bad it will be if you're exposed to the situation you fear and underestimate your ability to cope. The anxious thoughts that trigger and fuel phobias are usually negative and unrealistic. By writing down the negative thoughts you have when confronted by your phobia, you can begin to challenge these unhelpful ways of thinking. Many times, these thoughts fall into the following categories:
Fortune telling. For example, “This bridge is going to collapse;” “I'll make a fool of myself for sure;” “I will definitely lose it when the elevator doors close.”
Overgeneralization. “I fainted once while getting a shot. I'll never be able to get a shot again without passing out;” “That pit bull lunged at me. All dogs are dangerous.”
Catastrophizing. “The captain said we're going through turbulence. The plane is going to crash!” “The person next to me coughed. Maybe it's swine flu. I'm going to get very sick!”
Once you've identified your negative thoughts, evaluate them. Use the following example to get started.
Ask yourself the following 4 questions:
1. Is there any evidence that contradicts my negative thought?
Yes, for example: “People are currently using the elevator and it hasn’t broken down.”
“Even if it did break down, I’ve never heard of anyone dying from suffocation in an elevator. There are air vents which would stop the air from running out.”
“I’ve never been in an elevator that has broken down.”
2. Could you do anything to resolve this situation if it does occur?
“Yes, I could press the alarm or use the telephone to call for assistance.”
3. Are you thinking in an unhelpful way?
“I’m fortune telling, as there is no evidence to suggest that the elevator will break down or that I’d suffocate.”
4. What would you say to a friend who has this fear?
“I would tell a friend that the chances of the elevator breaking down are very slim, it’s not something you hear about happening very often.”
It's also helpful to come up with some positive coping statements that you can tell yourself when facing your phobia. For example:
NAMI Helpline – Trained volunteers can provide information, referrals, and support for those suffering from anxiety disorders in the U.S. Call 1-800-950-6264. (National Alliance on Mental Illness)
Find a Therapist – Search for anxiety disorder treatment providers in the U.S. (Anxiety Disorders Association of America)
Support Groups – List of support groups in the U.S., Canada, Australia, and South Africa. (Anxiety and Depression Association of America)
Anxiety UK – Information, support, and a dedicated helpline for UK sufferers and their families. Call: 03444 775 774. (Anxiety UK)
Anxiety Canada – Provides links to services in different Canadian provinces. (Anxiety Disorders Association of Canada)
SANE Help Centre – Provides information about symptoms, treatments, medications, and where to go for support in Australia. Call: 1800 18 7263. (SANE Australia).
Helpline (India) – Provides information and support to those with mental health concerns in India. Call: 1860 2662 345 or 1800 2333 330. (Vandrevala Foundation)
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