Anxiety, Fears, And Phobias

Everyone knows from their own experience what anxiety is. It is the most common complaint to psychotherapists, although only a fraction of anxious people see a therapist. More people visit regular MDs for anxiety than for colds. Where does the stress come from?

The causes change as we age: for children 6 to 10, it is often social difficulties in school or getting low grades. For 10 to 16, it is conflicts with parents and social pressures involving dating, drinking, and drugs. Teenagers troubled with a lot of anxiety are more likely to suffer mental health and addiction problems as adults. For 16 to 22, it is adjusting to school and the world of work. For adults, it is coping with children, marital strains, job stresses, and family conflicts. For the elderly, it is dealing with death, loneliness, and money problems.

As you can see, relationships are at the center of much of our anxiety. Humans suffer a lot of anxiety and general anxiety levels have steadily increased from 1950 to 2000. Apparently having lots of "things" (material goods) doesn't make us less stressed and emotionally more comfortable. About 7% of Americans have experienced a fairly serious level of anxiety during the last month.

It isn't unusual for someone's emotional distress to become quite severe. The Generalized Anxiety Disorder (GAD) is a chronic, debilitating condition that may involve excessive--sometimes 40 hours a week--and unrealistic worry and tension for at least 6 months, serious aches and pains, stomach trouble, insomnia, dizziness, irritability, unhappiness, poor concentration or other symptoms. The "worry" of people with GAD is more extensive and devastating than ordinary worries, e.g. 50% have trouble sleeping, 90% say it interfers with daily life and 60% with relationships, and 70% have always been an out-of-control worrier.

About 5% to 6% of us--more women than men--will have GAD sometime in their life. About 25% of all American adults believe they have "come close to a nervous breakdown." And, in reality, about that percent will have some kind of mental disorder, not necessarily GAD, sometime in their life. About 8% of all primary care patients are thought to have GAD. As high as 30% to 40% of us believe we have "excessive anxiety." No wonder over 30 million new prescriptions for tranquilizers are written every year.

Anxiety is not only a serious problem but it is complex with many facets. Furthermore, besides having to cope with a fear itself, the sufferer often has a stressful reaction because he/she had the fear. This is called a "second-order feeling." Just as there is a panic reaction to being told "you have cancer" or "you have heart disease," there is usually a strong negative reaction to having an intense fear or panic reaction or physical problems that interfere with work or cause disabling depression.

The second-order feelings might be regrets, dread, self-criticism and/or hopelessness, something like "What is wrong with me? What did I do wrong? Why can't I stop this feeling? There must be something wrong with me, I don't like me. I seem so helpless and worthless." That is, a second-order of stressful problems (self-doubts and self-criticism) develops that could overwhelm or sabotage the mending of the original problem (the performance anxiety).

When an unreasonable fear becomes serious enough to interfere with our work or social lives, it is called a phobia or a panic reaction. About 13% of us have had a phobia. There are three types of phobias: simple phobias (fear of death, cancer, insanity, the devil, the dark, enclosed places, heights, flying, storms, bugs, germs, spiders, mice, snakes, dogs, shallow water, etc.), social phobias (fears of public speaking, meeting people, having to introduce people, being judged, getting embarrassed, becoming confused, forgetting what you wanted to say, and the fear of being afraid), and panic disorders (unpredictable attacks of terror, sweating, weakness, pounding heart, dizziness, and a belief that he/she will lose control, go crazy, or die).

Many therapists believe that panic attacks that truly terrify us are physiologically and chemically different from our ordinary fears and anxiety. Panic disorders and agoraphobia, which is the most debilitating anxiety disorder and frequently associated with panic states, are discussed here.

Humans may be biologically "destined" (or inclined) to have certain social fears, e.g. of strangers at 18 months or so. Some overcome this "shyness" within a few months and others never do. Most of us also become afraid of the dark at age 3 or 4, and gradually overcome it to varying degrees. Animals too seem to have inborn tendencies to fear certain things.

Many humans fear snakes, rats, speaking, making mistakes, and other things. It is interesting that strong human phobias tend to be directed towards relatively harmless objects or vague, general situations--strangers, darkness, heights, insects, mice, meeting people, etc.--and not towards specific objects or situations that have actually hurt us or are serious physical dangers--electrical outlets, cars, mowers, bicycles, broken glass, rough walks, tools, such as saws, knives, or hammers, etc. Perhaps vague situations, like being in the dark, make solutions more difficult to see, make us feel less able to be in control, and also make it easier to imagine awful things happening.

Recently, some interesting physiological findings about gender differences in response to stress have been reported Under stress females produce, along with many other stress-related reactions, a lot more of a hormone called oxytocin than men who, of course, produce more testosterone.

The significance of this is that oxytocin has also been associated with relaxation and social interaction. Many studies of anxiety and many clinical observations report that women often respond to stress by "tending" to others, such as children or family, and by "befriending," such as getting together and talking with friends. Both of these responses would not only divert attention from the threat but also usually place her in a safer situation.

Thus, in men, on whom most of the research has been done, stress has been described for decades by authorities and science as definitely leading to "fight or flight" responses (a tendency which is, one would suppose, augmented by testosterone). Observations also suggest that men prefer to handle stress by themselves. In women, we are lucky to have a new theory about stress possibly leading to "tend and befriend" responses, both because those are the roles prescribed by our culture for women and because women's bodies may have learned or grown to respond to stresses with different juices than men.

Debates about these gender differences will hopefully lead to gathering more data and better understanding. At least, we are now free to consider optional additional reactions to stress beyond just fight and flight. Surely it would be wise to develop a repertoire of responses to stress, depending on the circumstances. Choices would certainly include attacking the threat in assorted ways, fleeing in a variety of ways, diverting attention via TV, reading, journaling, distracting one's attention by socializing, engaging in tending chores, such as child care, hobbies, To-Do-Lists, doing extra work or getting a second job, throwing one's self into solving the problems causing the stress, and so on.

It would certainly be a mistake to assume that biology is always in control--that little squirts of hormones will dictate what you do under stress. Regardless of oxytocin, some women respond to stress sometimes with aggression and with flight, and regardless of testosterone, men can respond with tending and befriending responses to stress. An angry response is sometimes appropriate and needed. However, an angry response to every stress would be very maladaptive. You want to learn and use many ways to reduce stress. Remain flexible in spite of general "laws" of behavior and specific hormones.

For unknown reasons, social phobias and panic attacks often start between 15 and 25 years of age. As with anxiety, women are three or four times more likely than men to have a specific phobia. Phobias occasionally start in childhood and gradually build (most children out grow their fears) or suddenly occur during a routine activity, e.g. one flight attendant panicked on her 500th flight. Obviously, science does not understand everything about fears--the chapter has reviewed many theories, however. That's the best we can do.

The treatment of fears and anxiety usually consists of a few methods,, especially exposure and frequent relaxation. Remember, stress may come (according to current theories) from (a) genes, (b) conditioning--classical, operant, or observational, (c) cognitive processes--faulty perceptions, irrational ideas, or faulty conclusions, and (d) childhood experiences, conflicts, or traumas. The best cure probably depends on the assumed cause, but we don't understand stress that well yet. In general, the treatment of choice for a simple phobia is usually exposure in some form to the situation.

However, the correction of anxiety-causing false beliefs also helps reduce fears and may be all that is needed. For social phobias and other situations requiring skills, the learning of useful skills is critical before or soon after reducing the fear response in the situation.

Examples: the young boy or girl who is afraid of a pitched ball needs to learn how to avoid being hit and how to hit the ball; the shy person must learn how to start conversations, how to self-disclose, and how to listen empathically; the test phobic student needs to learn how to study, how to write, and how to spend the hours memorizing the material, for example.

If you desire further information, please contact the EAP at 866/443-3277. You may also want to read the associated articles.